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General NPI Number Information
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NPI Number | 1306116801
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Entity Type | Organization
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Legal Business Name | HOPE MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 12/31/2011
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 92 ALLEN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4562
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Country | US
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Telephone | 802-773-7502
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Fax | 802-773-7022
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Provider Business Mailing Address
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Address Line | 92 ALLEN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4562
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Country | US
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Telephone | 802-773-7502
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Fax | 802-773-7022
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUSAN F DUMAS
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Credential | NP
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Telephone | 802-773-7502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 1010015655
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License Number State | VT
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