Healthcare Provider Details

I. General information

NPI: 1306116801
Provider Name (Legal Business Name): HOPE MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2011
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 ALLEN ST
RUTLAND VT
05701-4562
US

IV. Provider business mailing address

92 ALLEN ST
RUTLAND VT
05701-4562
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-7502
  • Fax: 802-773-7022
Mailing address:
  • Phone: 802-773-7502
  • Fax: 802-773-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number1010015655
License Number StateVT

VIII. Authorized Official

Name: MRS. SUSAN F DUMAS
Title or Position: OWNER
Credential: NP
Phone: 802-773-7502