Provider Demographics
NPI:1376560466
Name:HOMETOWN MEDICAL LLC
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:PITLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-734-7800
Mailing Address - Street 1:7711 N OAK TRFY
Mailing Address - Street 2:SUITE R
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1712
Mailing Address - Country:US
Mailing Address - Phone:816-734-7800
Mailing Address - Fax:816-734-7801
Practice Address - Street 1:7711 N OAK TRFY
Practice Address - Street 2:SUITE R
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1712
Practice Address - Country:US
Practice Address - Phone:816-734-7800
Practice Address - Fax:816-734-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626275507Medicaid
MO5736780001Medicare NSC