Provider Demographics
NPI:1144607771
Name:HOPE MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:HOPE MEDICAL CLINIC, INC.
Other - Org Name:HOPE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-484-2989
Mailing Address - Street 1:518 HARRIET ST
Mailing Address - Street 2:PO BOX 980311
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5358
Mailing Address - Country:US
Mailing Address - Phone:734-484-2989
Mailing Address - Fax:734-484-6825
Practice Address - Street 1:33608 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4673
Practice Address - Country:US
Practice Address - Phone:734-710-6688
Practice Address - Fax:734-710-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty