Provider Demographics
NPI:1750527644
Name:HOPE MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:HOPE MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FOR BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-837-8050
Mailing Address - Street 1:150 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2402
Mailing Address - Country:US
Mailing Address - Phone:850-837-8050
Mailing Address - Fax:850-837-2067
Practice Address - Street 1:150 BEACH DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2402
Practice Address - Country:US
Practice Address - Phone:850-837-8050
Practice Address - Fax:850-837-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82437261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care