MEDICARE: NEW HOPE MEDICAL CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine		MS

General Provider Information

NPI Number	:	1679567556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HOPE MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	2110 LAKE LOWNDES RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-9655
Country	:	US
Telephone Number	:	662-329-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 LAKE LOWNDES RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-9655
Country	:	US
Telephone Number	:	662-329-4940
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LINDA LAMISON
Credential	:
Telephone Number	:	662-329-4940

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	10/22/2010

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