1780683102 NPI number — ANNA K HOPLA MD

Table of content: ANNA K HOPLA MD (NPI 1780683102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780683102 NPI number — ANNA K HOPLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOPLA
Provider First Name:
ANNA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780683102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 MOUNT PELIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38237-3812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-200-0365
Provider Business Mailing Address Fax Number:
731-200-0366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 MOUNT PELIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38237-3812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-200-0365
Provider Business Practice Location Address Fax Number:
731-200-0366
Provider Enumeration Date:
07/18/2005

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: 207RN0300X , with the licence number:  MD26278 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1985133 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: T215215542 . This is a "MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4337915 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870643 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3088571 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3006275 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3064296 . This is a "BCBS - NEPHROLOGY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P02632436 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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