1710985908 NPI number — MR. WILLIAM R HOOPER CRNA

Table of content: MR. WILLIAM R HOOPER CRNA (NPI 1710985908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710985908 NPI number — MR. WILLIAM R HOOPER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOPER
Provider First Name:
WILLIAM
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOOPER
Provider Other First Name:
DICK
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA P.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710985908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2394 FM 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76645-5241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-553-1061
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2394 FM 309
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76645-5241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-553-1061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2005

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: 367500000X , with the licence number:  542725 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 209-005235 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 512159967B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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