Provider Demographics
NPI:1245569987
Name:HOMETOWN HEALTHCARE INC.
Entity Type:Organization
Organization Name:HOMETOWN HEALTHCARE INC.
Other - Org Name:HOMETOWN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-456-4630
Mailing Address - Street 1:107 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-2225
Mailing Address - Country:US
Mailing Address - Phone:662-456-4630
Mailing Address - Fax:662-456-2262
Practice Address - Street 1:101 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2174
Practice Address - Country:US
Practice Address - Phone:662-324-8338
Practice Address - Fax:662-324-9466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMETOWN HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-09
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06521081Medicaid
5508950002Medicare NSC