Provider Demographics
NPI:1700286598
Name:HOMETOWN FAMILY CLINIC OF CYNTHIANA
Entity Type:Organization
Organization Name:HOMETOWN FAMILY CLINIC OF CYNTHIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-234-5600
Mailing Address - Street 1:1134 US HIGHWAY 27 S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-4177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1134 US HIGHWAY 27 S
Practice Address - Street 2:SUITE 2
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-4177
Practice Address - Country:US
Practice Address - Phone:859-234-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care