Provider Demographics
NPI:1447853122
Name:HOOS PEDIATRIC AND ADOLESCENT CARE, PLLC
Entity type:Organization
Organization Name:HOOS PEDIATRIC AND ADOLESCENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HOOS
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:918-910-7991
Mailing Address - Street 1:904 WEST OKMULOGEE
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:904 WEST OKMULOGEE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6841
Practice Address - Country:US
Practice Address - Phone:918-910-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty