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General NPI Number Information
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NPI Number | 1558409698
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Entity Type | Organization
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Legal Business Name | HOMETOWN HEALTHCARE PC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 955 HIGH ST STE 2
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City | DECATUR
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State | IN
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Zip | 46733-2326
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Country | US
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Telephone | 260-724-8700
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Fax | 260-728-3821
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Provider Business Mailing Address
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Address Line | 955 HIGH ST STE 2
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City | DECATUR
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State | IN
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Zip | 46733-2326
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Country | US
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Telephone | 260-724-8700
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Fax | 260-728-3821
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MICHAEL E AINSWORTH
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Credential | MD
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Telephone | 206-724-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71001926A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01045263A
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License Number State | IN
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