Healthcare Provider Details

I. General information

NPI: 1942051842
Provider Name (Legal Business Name): HOMETOWN FAMILY MEDICINE AND URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2462 E HILL RD
GRAND BLANC MI
48439-5427
US

IV. Provider business mailing address

6232 ATLAS VALLEY DR
GRAND BLANC MI
48439-7804
US

V. Phone/Fax

Practice location:
  • Phone: 810-569-9514
  • Fax:
Mailing address:
  • Phone: 810-569-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN GALLIWAY
Title or Position: PRESIDENT
Credential: PA-C
Phone: 810-569-9514