MEDICARE: HOMETOWN HEALTHCARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	06827/11.1	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265486658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	107 E WASHINGTON ST
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851-2225
Country	:	US
Telephone Number	:	662-456-4630
Fax Number	:	662-456-2262

Provider Business Practice Location Address
First Line	:	107 E WASHINGTON ST
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851-2225
Country	:	US
Telephone Number	:	662-456-4630
Fax Number	:	662-456-2262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN S. KILGORE
Credential	:
Telephone Number	:	662-456-4630

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/09/2011

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