Basic Information
| Provider Information | |||||||||
| NPI: | 1083669535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOKS | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | BENNETT SLADE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOOKS | ||||||||
| OtherFirstName: | BENNETT | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | III | ||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1720 SPRINGHILL AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514351200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1720 SPRINGHILL AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514351200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 38197 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 00027276 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N2568 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | N2568 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | P2286011 | 01 | TN | FIRST HEALTH | OTHER | 7473694 | 01 | TN | AETNA | OTHER | 8890116 | 01 | TN | CIGNA | OTHER | 4106745 | 01 | TN | BCBS | OTHER | I32091 | 01 | TN | HEALTHSPRING | OTHER | 4106745 | 01 | TN | TENNCARE | OTHER | P00243561 | 01 | TN | R/R MEDICARE | OTHER | 3330681 | 05 | TN | MEDICAID |