NPIMap

Organization Active NPI

Hope Medical Holistic Clinic PLLC

  • Adult Medicine Physician
  • Vancouver, WA
National Provider Identifier
1194866509
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
MD00039350 Issued in WA
Legal business name
HOPE MEDICAL HOLISTIC CLINIC PLLC
Practice address
3606 Main Street
Ste 105
Vancouver, WA 98663-2235
Phone
(360) 750-9292
Fax
(360) 750-9290
NPI assigned
Feb 9, 2007
Last updated
Jul 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Zbigniew M Grudzien, M.D.
Title
General Practitioner
Phone
(360) 750-9292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X MD00039350 WA Primary

Addresses

Primary practice location

3606 Main Street
Ste 105
Vancouver, WA 98663-2235

Mailing address

3606 Main Street
Ste 105
Vancouver, WA 98663-2235
Phone (360) 750-9292

Other identifiers 1

IdentifierTypeStateIssuer
1121391MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279238400000",
    "number": "1194866509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 MAIN STREET",
            "address_2": "STE 105",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986632235",
            "telephone_number": "360-750-9292",
            "fax_number": "360-750-9290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3606 MAIN STREET",
            "address_2": "STE 105",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986632235",
            "telephone_number": "360-750-9292",
            "fax_number": "360-750-9290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOPE MEDICAL HOLISTIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2010-07-16",
        "status": "A",
        "authorized_official_last_name": "GRUDZIEN",
        "authorized_official_first_name": "ZBIGNIEW",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "GENERAL PRACTITIONER",
        "authorized_official_telephone_number": "360-750-9292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "WA",
            "license": "MD00039350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1121391",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.