Healthcare Provider Details

I. General information

NPI: 1558409698
Provider Name (Legal Business Name): HOMETOWN HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 HIGH ST STE 2
DECATUR IN
46733-2326
US

IV. Provider business mailing address

955 HIGH ST STE 2
DECATUR IN
46733-2326
US

V. Phone/Fax

Practice location:
  • Phone: 260-724-8700
  • Fax: 260-728-3821
Mailing address:
  • Phone: 260-724-8700
  • Fax: 260-728-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01045263A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001926A
License Number StateIN

VIII. Authorized Official

Name: MICHAEL E AINSWORTH
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 206-724-8700