Provider Demographics
NPI:1639777378
Name:HOMETOWN MEDICAL PLLC
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PA-C
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:I
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-474-0050
Mailing Address - Street 1:130 PINE STATE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546
Mailing Address - Country:US
Mailing Address - Phone:910-474-0050
Mailing Address - Fax:863-228-8484
Practice Address - Street 1:130 PINE STATE ST
Practice Address - Street 2:SUITE C
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-474-0050
Practice Address - Fax:863-228-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922562834OtherTRICARE
NC1922562834OtherBCBS
NC1922562834Medicaid
NC1922562834OtherUNITED HEALTHCARE