Provider Demographics
NPI:1851837017
Name:HOME TOWN CLINIC
Entity Type:Organization
Organization Name:HOME TOWN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-726-0200
Mailing Address - Street 1:101 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1117
Mailing Address - Country:US
Mailing Address - Phone:606-726-0200
Mailing Address - Fax:606-726-0226
Practice Address - Street 1:101 RIVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1117
Practice Address - Country:US
Practice Address - Phone:606-726-0200
Practice Address - Fax:606-726-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care