Provider Demographics
NPI:1700961836
Name:HOPE UNLIMITED FAMILY CARE CENTER
Entity Type:Organization
Organization Name:HOPE UNLIMITED FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:270-442-1166
Mailing Address - Street 1:1101 JEFFERSON ST
Mailing Address - Street 2:P.O. BOX 7403
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-1835
Mailing Address - Country:US
Mailing Address - Phone:270-442-1166
Mailing Address - Fax:270-442-9948
Practice Address - Street 1:1101 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-1835
Practice Address - Country:US
Practice Address - Phone:270-442-1166
Practice Address - Fax:270-442-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X, 261QA0005X
KY1046053261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX ID