Healthcare Provider Details

I. General information

NPI: 1235214826
Provider Name (Legal Business Name): THE HOPE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST SUITE 210
BRISTOL CT
06010-8102
US

IV. Provider business mailing address

10 N MAIN ST SUITE 210
BRISTOL CT
06010-8102
US

V. Phone/Fax

Practice location:
  • Phone: 860-589-4673
  • Fax: 860-589-6124
Mailing address:
  • Phone: 860-589-4673
  • Fax: 860-589-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VIRGINIA M TJAN-WETTSTEIN
Title or Position: PHYSICIAN / OWNER
Credential: M.D.
Phone: 860-589-4673