Provider Demographics
NPI:1578764312
Name:HOPE PHYSICIANS
Entity Type:Organization
Organization Name:HOPE PHYSICIANS
Other - Org Name:HOPE PHYSICIANS AND URGENT CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:SUNDAY
Authorized Official - Last Name:OKONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-522-3663
Mailing Address - Street 1:2502 N HERRITAGE STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-3567
Mailing Address - Country:US
Mailing Address - Phone:252-522-3663
Mailing Address - Fax:252-522-3660
Practice Address - Street 1:2502 N HERRITAGE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3567
Practice Address - Country:US
Practice Address - Phone:252-522-3663
Practice Address - Fax:252-522-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900633261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126AGMedicaid
NC229770Medicare PIN
NC89126AGMedicaid