MEDICARE: HOMETOWN MEDICAL LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1821445610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN MEDICAL LLC

Provider Business Mailing Address
First Line	:	1736 ALEXANDRIA DR
Second Line	:	STE 100
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3160
Country	:	US
Telephone Number	:	859-263-2204
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 ALEXANDRIA DR
Second Line	:	STE 100
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3160
Country	:	US
Telephone Number	:	859-263-2204
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	LAWRENCE YORK
Credential	:
Telephone Number	:	859-263-2204

Provider Enumeration Date	:	05/21/2016
Last Update Date	:	05/21/2016

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