Healthcare Provider Details

I. General information

NPI: 1144896564
Provider Name (Legal Business Name): HOPELIGHT MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 COLLYER ST
LONGMONT CO
80501-3310
US

IV. Provider business mailing address

1351 COLLYER ST
LONGMONT CO
80501-3310
US

V. Phone/Fax

Practice location:
  • Phone: 303-776-2625
  • Fax: 888-863-4354
Mailing address:
  • Phone: 303-776-2625
  • Fax: 888-863-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD BOWEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-776-2625