Basic Information
| Provider Information | |||||||||
| NPI: | 1407122625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOPEWELL | ||||||||
| FirstName: | PAIGE | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2202 N NEW JERSEY ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462054336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179025626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 WEST 86TH STREET | ||||||||
| Address2: | DEPARTMENT OF MEDICAL EDUCATION | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173382281 | ||||||||
| FaxNumber: | 3173386359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 50674 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | K250540 | 01 | KY | MEDICARE | OTHER |