Provider Demographics
NPI:1184793986
Name:HOMETOWN FAMILY CARE PLLC
Entity type:Organization
Organization Name:HOMETOWN FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-226-2492
Mailing Address - Street 1:100 AIRPORT GARDENS ROAD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-7529
Mailing Address - Country:US
Mailing Address - Phone:606-487-7524
Mailing Address - Fax:606-439-6927
Practice Address - Street 1:400 UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1080
Practice Address - Country:US
Practice Address - Phone:606-886-3831
Practice Address - Fax:606-886-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65943508Medicaid
09632Medicare ID - Type Unspecified