MEDICARE: HOPKINS SURGICAL ASSISTANCE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA2314 & PA2614	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC7366	OTHER	FL	RAILROAD GROUP #
2	X1569	OTHER	FL	BCBS GROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417036450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPKINS SURGICAL ASSISTANCE, INC.

Provider Business Mailing Address
First Line	:	36181 E LAKE RD # 390
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3142
Country	:	US
Telephone Number	:	727-781-8685
Fax Number	:	727-786-2852

Provider Business Practice Location Address
First Line	:	36181 E LAKE RD # 390
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3142
Country	:	US
Telephone Number	:	727-781-8685
Fax Number	:	727-786-2852

Authorized Official
Title or Position	:	VP/SEC
Name	:	MRS. BEVERLY HOPKINS
Credential	:	CO-OWNER
Telephone Number	:	727-781-8685

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/07/2015

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