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General NPI Number Information
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NPI Number | 1326544875
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Entity Type | Organization
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Legal Business Name | HOMETOWN URGENT CARE, LLC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 731 E STATE HIGHWAY 152
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City | MUSTANG
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State | OK
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Zip | 73064-4520
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Country | US
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Telephone | 405-324-5566
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Fax | 405-324-5628
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Provider Business Mailing Address
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Address Line | 14936 SW 65TH ST
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City | MUSTANG
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State | OK
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Zip | 73064-9599
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Country | US
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Telephone | 405-818-7425
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Fax | 405-324-5628
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Authorized Official
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Title or Position | PHYSICIAN
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Name | REBECCA BIORATO
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Credential | DO
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Telephone | 405-818-7425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 4174
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License Number State | OK
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