Provider Demographics
NPI:1205017860
Name:HOPE CLINIC LLC
Entity Type:Organization
Organization Name:HOPE CLINIC LLC
Other - Org Name:HOPE CLINIC - NORTH CHARLESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMISAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ETIKERENTSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-725-4673
Mailing Address - Street 1:5880 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6053
Mailing Address - Country:US
Mailing Address - Phone:843-725-4673
Mailing Address - Fax:843-725-1235
Practice Address - Street 1:5880 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-725-4673
Practice Address - Fax:843-725-1235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20234OtherSTATE LICENSE
SC20067813-001OtherFIRST CHOICE
SCGP4815Medicaid
SC75767OtherSC PCF
SCJB021584OtherJUA
SCJB021584OtherJUA
SC20234OtherSTATE LICENSE