Provider Demographics
NPI:1033295019
Name:HOPKINS, SCOTT JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JOHN
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 E CREEKS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8368
Mailing Address - Country:US
Mailing Address - Phone:812-355-2300
Mailing Address - Fax:812-355-2317
Practice Address - Street 1:2605 E CREEKS EDGE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8368
Practice Address - Country:US
Practice Address - Phone:812-355-2300
Practice Address - Fax:812-355-2317
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA731363AM0700X
IN10000365A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400039174Medicare PIN