Provider Demographics
NPI:1831520667
Name:FUTURE HOPE CLINIC LLC
Entity type:Organization
Organization Name:FUTURE HOPE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD/PHD
Authorized Official - Phone:719-299-3012
Mailing Address - Street 1:3116 N ELIZABETH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1145
Mailing Address - Country:US
Mailing Address - Phone:719-299-3012
Mailing Address - Fax:719-299-3013
Practice Address - Street 1:3116 N ELIZABETH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1145
Practice Address - Country:US
Practice Address - Phone:719-299-3012
Practice Address - Fax:719-299-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08658285Medicaid