Healthcare Provider Details

I. General information

NPI: 1033074174
Provider Name (Legal Business Name): TONY HOPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 MONROE ST
CLINTON MS
39056-3736
US

IV. Provider business mailing address

1108 MONROE ST
CLINTON MS
39056-3736
US

V. Phone/Fax

Practice location:
  • Phone: 414-204-4000
  • Fax: 414-249-5891
Mailing address:
  • Phone: 414-204-4000
  • Fax: 414-249-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: