1477782092 NPI number — TAMARA V HOPKINS, MD, LLC

Table of content: (NPI 1477782092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477782092 NPI number — TAMARA V HOPKINS, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
TAMARA V HOPKINS, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477782092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 CHRISTY DR
Provider Second Line Business Mailing Address:
SUITE #201
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65101-5195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-635-0621
Provider Business Mailing Address Fax Number:
573-635-3534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2009 SAINT MARYS BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65109-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-634-7155
Provider Business Practice Location Address Fax Number:
573-634-3146
Provider Enumeration Date:
07/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
573-634-7155

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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