Provider Demographics
NPI:1124579511
Name:HOPELIGHT MEDICAL CLINIC
Entity type:Organization
Organization Name:HOPELIGHT MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-776-7117
Mailing Address - Street 1:1351 COLLYER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3310
Mailing Address - Country:US
Mailing Address - Phone:303-776-7117
Mailing Address - Fax:888-863-4354
Practice Address - Street 1:1351 COLLYER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3310
Practice Address - Country:US
Practice Address - Phone:303-776-7117
Practice Address - Fax:888-863-4354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPELIGHT MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-20
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57970050Medicaid