Provider Demographics
NPI:1164042412
Name:HOMETOWN DIRECT PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:HOMETOWN DIRECT PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAMBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-901-7344
Mailing Address - Street 1:3949 CHALYBEATE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-6207
Mailing Address - Country:US
Mailing Address - Phone:919-910-7344
Mailing Address - Fax:319-250-7453
Practice Address - Street 1:332 N BRIGHTLEAF BLVD STE C
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4604
Practice Address - Country:US
Practice Address - Phone:919-901-7344
Practice Address - Fax:319-250-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care