Healthcare Provider Details

I. General information

NPI: 1194778977
Provider Name (Legal Business Name): MARK E HOPKINS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD 2ND FLOOR ANESTHESIA DEPT
GREENVILLE SC
29605-5611
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7111
  • Fax: 864-455-6441
Mailing address:
  • Phone: 864-797-6307
  • Fax: 864-797-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN2346
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: