1194386573 NPI number — MELANIE HOPF PA-C

Table of content: MELANIE HOPF PA-C (NPI 1194386573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194386573 NPI number — MELANIE HOPF PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOPF
Provider First Name:
MELANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
MELANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194386573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-907-0356
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 1ST AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47546-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-476-7111
Provider Business Practice Location Address Fax Number:
812-476-7117
Provider Enumeration Date:
06/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7208763 . This is a "UNITED HEALTHCARE PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4850947 . This is a "AETNA PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14537527 . This is a "CAQH PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000001304395 . This is a "ANTHEM PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300029983 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6810994 . This is a "CIGNA PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100620060 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS2000300388 . This is a "CARESOURCE PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PDZ000000326011 . This is a "AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2013903 . This is a "WELLCARE OF KY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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