| Hope Medical Clinic Pllc | |
|
92 Allen St Rutland VT 05701-4562 | |
| (802) 773-7502 | |
| (802) 773-7022 |
| Full Name | Hope Medical Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 92 Allen St, Rutland, Vermont |
| Authorized Official Name and Position | Susan F Dumas (OWNER) |
| Authorized Official Contact | 8027737502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hope Medical Clinic Pllc 92 Allen St Rutland VT 05701-4562 Ph: (802) 773-7502 | Hope Medical Clinic Pllc 92 Allen St Rutland VT 05701-4562 Ph: (802) 773-7502 |
| NPI Number | 1306116801 |
|---|---|
| Provider Enumeration Date | 12/31/2011 |
| Last Update Date | 04/17/2017 |
| Medicare PECOS PAC ID | 4385804251 |
|---|---|
| Medicare Enrollment ID | O20120330000043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306116801 | NPI | - | NPPES |
| 0025803 | Other | VT | MEDICARE PTAN |
| 5501740 | Other | VT | MVP |
| 1008529 | Medicaid | VT | |
| 1020249 | Other | VT | MEDICAID FOR HOPE MEDICAL CLINIC |
| 47D2040632 | Other | CLIA WAIVER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 1010015655 (Vermont) | Primary |
| Provider Name | Susan Frances Dumas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477514362 PECOS PAC ID: 1557392206 Enrollment ID: I20050823000626 |
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