Provider Demographics
NPI:1679171995
Name:NEW HOPE MEDICAL PRIMARY & URGENT CARE CLINIC, LLC
Entity Type:Organization
Organization Name:NEW HOPE MEDICAL PRIMARY & URGENT CARE CLINIC, LLC
Other - Org Name:NEW HOPE MEDICAL PRIMARY & URGENT CARE CLINIC , LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-822-0270
Mailing Address - Street 1:1850 LAKE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7439
Mailing Address - Country:US
Mailing Address - Phone:662-822-0270
Mailing Address - Fax:662-537-4176
Practice Address - Street 1:585 TENNESSEE GAS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8143
Practice Address - Country:US
Practice Address - Phone:662-822-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care