Provider Demographics
NPI:1790756484
Name:HOMETOWN MEDICAL SERVICES
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:901-476-9996
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TN
Mailing Address - Zip Code:38049-0305
Mailing Address - Country:US
Mailing Address - Phone:901-476-9996
Mailing Address - Fax:901-476-9986
Practice Address - Street 1:3909 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-2281
Practice Address - Country:US
Practice Address - Phone:901-476-9996
Practice Address - Fax:901-476-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN102421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN300133047Medicaid
TNP65398Medicare UPIN
TN3723228Medicare PIN