Provider Demographics
NPI:1538486790
Name:HOMETOWN HEALTHCARE LLC
Entity Type:Organization
Organization Name:HOMETOWN HEALTHCARE LLC
Other - Org Name:GARFIELD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:830-879-2279
Mailing Address - Street 1:P. O. BOX 2070
Mailing Address - Street 2:
Mailing Address - City:ORANGE GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78372-2070
Mailing Address - Country:US
Mailing Address - Phone:830-879-2279
Mailing Address - Fax:830-879-2235
Practice Address - Street 1:205 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017-3500
Practice Address - Country:US
Practice Address - Phone:830-965-4466
Practice Address - Fax:830-965-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04256261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22876Medicare UPIN
TX673888Medicare Oscar/Certification