Healthcare Provider Details

I. General information

NPI: 1881911030
Provider Name (Legal Business Name): HOMETOWN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N GIRAUD
COTULLA TX
78014-3113
US

IV. Provider business mailing address

PO BOX 2070
ORANGE GROVE TX
78372-2070
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-2279
  • Fax: 830-879-2235
Mailing address:
  • Phone: 830-879-2279
  • Fax: 830-879-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberPA04256
License Number StateTX

VIII. Authorized Official

Name: MR. WILL D THOMPSON
Title or Position: PRESIDENT
Credential: PA-C
Phone: 830-879-2279