MEDICARE: HOPE FAMILY MEDICINE CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	599032	TX

General Provider Information

NPI Number	:	1770882524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE FAMILY MEDICINE CLINIC INC

Provider Business Mailing Address
First Line	:	6138 LINNHAVEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1530
Country	:	US
Telephone Number	:	281-394-3867
Fax Number	:

Provider Business Practice Location Address
First Line	:	6138 LINNHAVEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1530
Country	:	US
Telephone Number	:	281-394-3867
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLUFOLAKE OGUNLADE
Credential	:	NPC
Telephone Number	:	281-394-3867

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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