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SHEPHERD OF HOPE CLINIC PC NPI 1225014715


NPI Information

NPI: 1225014715
Provider Name: SHEPHERD OF HOPE CLINIC PC
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
1028 HANNAH AVE
SUITE D
TRAVERSE CITY, MI
ZIP 49686
Phone: (231) 946-7360
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SHEPHERD OF HOPE CLINIC PC is a general practice in Traverse City, MI. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee SHEPHERD OF HOPE CLINIC PC NPI is 1225014715. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1028 HANNAH AVE
SUITE D
TRAVERSE CITY, MI
ZIP 49686-963
Phone: (231) 946-7360
Fax: (231) 929-4775

The provider's authorized official is Douglas John Wigton .
The authorized official title is Director and has the following contact phone number (231) 946-7360.

The enumeration date for this NPI number is 12/16/2005 and was last updated on 7/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeMICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12100506MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.