Healthcare Provider Details

I. General information

NPI: 1437529260
Provider Name (Legal Business Name): HOPE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 RIVERS AVE
NORTH CHARLESTON SC
29406-6053
US

IV. Provider business mailing address

5880 RIVERS AVE
NORTH CHARLESTON SC
29406-6053
US

V. Phone/Fax

Practice location:
  • Phone: 843-725-4673
  • Fax: 843-725-1235
Mailing address:
  • Phone: 843-725-4673
  • Fax: 843-725-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number24720000X
License Number StateSC

VIII. Authorized Official

Name: DR. TEMISAN ETIKERENTSE
Title or Position: MEDICAL PROVIDER
Credential: M.D
Phone: 843-725-4673