Provider Demographics
NPI:1275361354
Name:HOPE MEDICAL GROUP GRANITE PLLC
Entity type:Organization
Organization Name:HOPE MEDICAL GROUP GRANITE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-451-5722
Mailing Address - Street 1:1602 21ST ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-5304
Mailing Address - Country:US
Mailing Address - Phone:618-451-5722
Mailing Address - Fax:618-451-9092
Practice Address - Street 1:1602 21ST ST
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-5304
Practice Address - Country:US
Practice Address - Phone:618-451-5722
Practice Address - Fax:618-451-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty