Provider Demographics
NPI:1982270567
Name:HOPE MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:HOPE MEDICAL CLINIC PA
Other - Org Name:HOPE MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:IYASU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-500-0909
Mailing Address - Street 1:3609 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4457
Mailing Address - Country:US
Mailing Address - Phone:910-500-0909
Mailing Address - Fax:910-920-4224
Practice Address - Street 1:3609 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4457
Practice Address - Country:US
Practice Address - Phone:910-500-0909
Practice Address - Fax:910-920-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty