Healthcare Provider Details

I. General information

NPI: 1255437844
Provider Name (Legal Business Name): HOMETOWN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 BELMONT STREET
VICKSBURG MS
39180
US

IV. Provider business mailing address

1019 TOWN DR
HIGHLAND HEIGHTS KY
41076-9114
US

V. Phone/Fax

Practice location:
  • Phone: 601-634-6363
  • Fax: 601-634-6380
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J CRAWFORD
Title or Position: CEO
Credential:
Phone: 859-441-8876