Provider Demographics
NPI:1669640686
Name:KEN C HOPPER MD PA
Entity Type:Organization
Organization Name:KEN C HOPPER MD PA
Other - Org Name:THE HOPPER GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-274-8800
Mailing Address - Street 1:801 ROAD TO SIX FLAGS W STE 145
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2600
Mailing Address - Country:US
Mailing Address - Phone:817-274-8800
Mailing Address - Fax:817-274-8806
Practice Address - Street 1:801 ROAD TO SIX FLAGS W STE 145
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2600
Practice Address - Country:US
Practice Address - Phone:817-274-8800
Practice Address - Fax:817-274-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH55122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D38AOtherMEDIARE ID
TX00D38AOtherMEDIARE ID