Provider Demographics
NPI:1962024018
Name:HOMETOWN FAMILY MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:HOMETOWN FAMILY MEDICAL CLINIC, LLC
Other - Org Name:HOMETOWN FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:870-270-6935
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:AR
Mailing Address - Zip Code:72372
Mailing Address - Country:US
Mailing Address - Phone:870-270-6935
Mailing Address - Fax:
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:AR
Practice Address - Zip Code:72372
Practice Address - Country:US
Practice Address - Phone:870-270-6935
Practice Address - Fax:949-655-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty