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General NPI Number Information
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NPI Number | 1053803643
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Entity Type | Organization
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Legal Business Name | NEW HOPE MEDICAL CLINIC, PC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 3670 S NEW HOPE RD
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City | GASTONIA
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State | NC
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Zip | 28056-8596
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Country | US
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Telephone | 704-824-4560
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Fax |
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Provider Business Mailing Address
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Address Line | 3670 S NEW HOPE RD
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City | GASTONIA
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State | NC
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Zip | 28056-8596
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Country | US
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Telephone | 704-824-4560
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE MANAGER
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Name | KONRAD HELMUT KAEDING
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Credential |
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Telephone | 302-518-3022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 34D1098072
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License Number State | NC
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