Provider Demographics
NPI:1366837585
Name:NEW HOPE MEDICINE CLINICAL PREVENTATIVE SERVICES
Entity type:Organization
Organization Name:NEW HOPE MEDICINE CLINICAL PREVENTATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-250-5252
Mailing Address - Street 1:PO BOX 7625
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-0625
Mailing Address - Country:US
Mailing Address - Phone:406-393-2098
Mailing Address - Fax:406-393-2097
Practice Address - Street 1:8 1ST ST E STE 104
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6119
Practice Address - Country:US
Practice Address - Phone:406-393-2098
Practice Address - Fax:406-393-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10150261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center