=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386911808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWHOPE MINISTRIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2011
-----------------------------------------------------
Last Update Date | 11/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 S. COURT STREET
-----------------------------------------------------
City | OWINGSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40360-1088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-674-8822
-----------------------------------------------------
Fax | 606-674-8262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 1088 41 S. COURT STREET
-----------------------------------------------------
City | OWINGSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40360-1088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-674-8822
-----------------------------------------------------
Fax | 606-674-8262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR
-----------------------------------------------------
Name | MR. WILLIAM ROBERT GRIMES
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 606-674-8822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 740144
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------