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General NPI Number Information
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NPI Number | 1235877697
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Entity Type | Organization
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Legal Business Name | HOMETOWN HEALTHCARE AND PEDIATRICS LLC
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 315 N MAIN ST
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City | TRENTON
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State | FL
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Zip | 32693-3462
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Country | US
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Telephone | 352-246-8566
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Fax | 734-322-0384
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Provider Business Mailing Address
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Address Line | 22856 SW 46TH AVE
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City | NEWBERRY
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State | FL
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Zip | 32669-4713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTEN WELCH
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Credential |
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Telephone | 352-246-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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