NPIMap

Organization Active NPI

Hope Medical Clinic LLC

Doing business as Hope Mobile Clinic

  • Family Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1407496219
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HOPE MEDICAL CLINIC LLC
Practice address
200 W Lake St
Minneapolis, MN 55408-3023
Phone
(952) 219-2773
NPI assigned
Jan 9, 2020
Organization subpart
Yes
Parent organization
HOPE MEDICAL CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Authorized official

Name
Dr. Judith Wanyama, APRN,CNPNPI 1265977466
Title
Provider
Phone
(763) 377-2069

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

200 W Lake St
Minneapolis, MN 55408-3023

Mailing address

7325 Zane Ave N
Brooklyn Park, MN 55443-3113
Phone (763) 377-2069

Other practice location 1

6818 Humboldt Ave N
Brooklyn Center, MN 55430-1536
Phone (763) 377-2069

Other names 2

  • HOPE MOBILE CLINIC Former legal business name
  • HOPE HEALTH INITIATIVE Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Hope Medical Clinic LLC2 organizations share this tax ID, including this one
Part of
Hope Medical Clinic LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6818 Humboldt Ave N
Brooklyn Center, MN 55430
Phone (763) 377-2069

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1407496219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7325 ZANE AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433113",
            "telephone_number": "763-377-2069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083023",
            "telephone_number": "952-219-2773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6818 Humboldt Ave N",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Center",
            "state": "MN",
            "postal_code": "554301536",
            "country_code": "US",
            "telephone_number": "763-377-2069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOPE MEDICAL CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOPE MEDICAL CLINIC",
        "enumeration_date": "2020-01-09",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "WANYAMA",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "763-377-2069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "APRN,CNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hope Mobile Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HOPE HEALTH INITIATIVE",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "HOPE MOBILE CLINIC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; 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.