Provider Demographics
NPI:1679700843
Name:NEW HOPE MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:NEW HOPE MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KONRAD
Authorized Official - Middle Name:HELMUT
Authorized Official - Last Name:KAEDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-518-3022
Mailing Address - Street 1:3670 S NEW HOPE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8597
Mailing Address - Country:US
Mailing Address - Phone:704-709-3239
Mailing Address - Fax:704-478-8194
Practice Address - Street 1:3670 S NEW HOPE RD STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056
Practice Address - Country:US
Practice Address - Phone:704-824-4560
Practice Address - Fax:704-824-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17583207Q00000X, 207Q00000X
207QA0401X, 207RA0401X, 208VP0000X, 207RA0401X, 208VP0014X
NC9300173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679700843Medicaid