Provider Demographics
NPI:1073705745
Name:HOPEWELL MEDICAL
Entity Type:Organization
Organization Name:HOPEWELL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-828-0334
Mailing Address - Street 1:114 KRAFT ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4910
Mailing Address - Country:US
Mailing Address - Phone:931-645-7866
Mailing Address - Fax:931-645-7766
Practice Address - Street 1:114 KRAFT ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4910
Practice Address - Country:US
Practice Address - Phone:931-645-7866
Practice Address - Fax:931-645-7766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL NECESSITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16522207R00000X, 208VP0000X
TN1864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4057165Medicaid
TN7574554OtherAETNA
TN10080916OtherAMERIGROUP
TN2566732OtherCIGNA
TN=========OtherWINDSOR MEDICARE
TN7574554OtherAETNA
TN2566732OtherCIGNA
TN4057165Medicaid
TN7574554OtherAETNA