Provider Demographics
NPI:1265869176
Name:HOMETOWN FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:HOMETOWN FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINNEA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-678-2069
Mailing Address - Street 1:3516 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2258
Mailing Address - Country:US
Mailing Address - Phone:816-756-5375
Mailing Address - Fax:816-756-5375
Practice Address - Street 1:6317 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4929
Practice Address - Country:US
Practice Address - Phone:816-353-3939
Practice Address - Fax:816-353-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008013774261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1770779530OtherINDIVIDUAL NPI