Provider Demographics
NPI:1982213666
Name:HOMETOWN FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:HOMETOWN FAMILY HEALTHCARE
Other - Org Name:HOMETOWN FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MCNITT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:918-789-8300
Mailing Address - Street 1:301 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-1637
Mailing Address - Country:US
Mailing Address - Phone:918-789-8300
Mailing Address - Fax:918-789-8302
Practice Address - Street 1:301 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-1637
Practice Address - Country:US
Practice Address - Phone:918-789-8300
Practice Address - Fax:918-789-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200813930AMedicaid
1487122347OtherINDIVIDUAL NPI