Provider Demographics
NPI:1134570328
Name:HOPE FAMILY MEDICAL CENTER LLC
Entity type:Organization
Organization Name:HOPE FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:JODY
Authorized Official - Last Name:STUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:385-275-4673
Mailing Address - Street 1:166 E 5900 S STE B109
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7293
Mailing Address - Country:US
Mailing Address - Phone:385-275-4673
Mailing Address - Fax:
Practice Address - Street 1:166 E 5900 S STE B109
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-7293
Practice Address - Country:US
Practice Address - Phone:385-275-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE FAMILY MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2231894405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty