Provider Demographics
NPI:1497920102
Name:HOPE FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:HOPE FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-234-2020
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-1250
Mailing Address - Country:US
Mailing Address - Phone:360-234-2020
Mailing Address - Fax:360-234-2026
Practice Address - Street 1:740 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-1250
Practice Address - Country:US
Practice Address - Phone:360-234-2020
Practice Address - Fax:360-234-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602822387261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care