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General NPI Number Information
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NPI Number | 1124662358
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Entity Type | Organization
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Legal Business Name | HOMETOWN ANCILLARY SERVICES LLC
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 1301 W 1ST ST
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City | SPRINGFIELD
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State | OH
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Zip | 45504-1920
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Country | US
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Telephone | 614-505-7633
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 CORPORATE EXCHANGE DR STE 102
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City | COLUMBUS
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State | OH
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Zip | 43231-7651
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Country | US
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Telephone | 614-505-7633
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Fax |
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Authorized Official
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Title or Position | DIR. OF CREDENTIALING AND CONTRACTI
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Name | CHRISTINE FIGLESTAHLER
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Credential |
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Telephone | 614-505-7633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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