Healthcare Provider Details

I. General information

NPI: 1831306992
Provider Name (Legal Business Name): HOPSCOTCH PRIMARY CARE GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E GROVER ST
SHELBY NC
28150-3803
US

IV. Provider business mailing address

113 E GROVER ST
SHELBY NC
28150-3803
US

V. Phone/Fax

Practice location:
  • Phone: 704-487-5228
  • Fax: 704-482-4284
Mailing address:
  • Phone: 704-487-5228
  • Fax: 704-482-4284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. THIRATH CHAU
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 337-860-4721