MEDICARE: HOMETOWN URGENT CARE OF MICHIGAN, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790030385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN URGENT CARE OF MICHIGAN, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 500
Second Line	:
City	:	ELLICOTTVILLE
State	:	NY
Zip	:	14731-0500
Country	:	US
Telephone Number	:	716-699-9032
Fax Number	:

Provider Business Practice Location Address
First Line	:	6210 BRANDT PIKE
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-4019
Country	:	US
Telephone Number	:	937-236-8630
Fax Number	:	937-236-8635

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN C RADFORD
Credential	:	MD
Telephone Number	:	716-699-9032

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	10/16/2024

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