Provider Demographics
NPI:1306116801
Name:HOPE MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:HOPE MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:802-773-7502
Mailing Address - Street 1:92 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4562
Mailing Address - Country:US
Mailing Address - Phone:802-773-7502
Mailing Address - Fax:802-773-7022
Practice Address - Street 1:92 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4562
Practice Address - Country:US
Practice Address - Phone:802-773-7502
Practice Address - Fax:802-773-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-31
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010015655261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0025803OtherMEDICARE PTAN
VT5501740OtherMVP
VT1008529Medicaid
VT1020249OtherMEDICAID FOR HOPE MEDICAL CLINIC
47D2040632OtherCLIA WAIVER