| Hope Clinic Llc | |
|
110 Executive Pkwy Moncks Corner SC 29461-3930 | |
| (843) 899-9099 | |
| (888) 318-5567 |
| Full Name | Hope Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 110 Executive Pkwy, Moncks Corner, South Carolina |
| Authorized Official Name and Position | Asante Wagner (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 8434084171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hope Clinic Llc 110 Executive Pkwy Moncks Corner SC 29461-3930 Ph: (843) 408-4171 | Hope Clinic Llc 110 Executive Pkwy Moncks Corner SC 29461-3930 Ph: (843) 899-9099 |
| NPI Number | 1144299470 |
|---|---|
| Provider Enumeration Date | 03/17/2006 |
| Last Update Date | 06/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144299470 | NPI | - | NPPES |
| 202346 | Medicaid | SC | |
| 4225947 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| GP3438 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20234 (South Carolina) | Primary |
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