Provider Demographics
NPI:1780721472
Name:HOMETOWN DOCTORS PC
Entity type:Organization
Organization Name:HOMETOWN DOCTORS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:VINOD
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-687-9990
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36072-0039
Mailing Address - Country:US
Mailing Address - Phone:334-687-9990
Mailing Address - Fax:334-687-9190
Practice Address - Street 1:617 E BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1710
Practice Address - Country:US
Practice Address - Phone:334-687-9990
Practice Address - Fax:334-687-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO 371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940932Medicaid
AL009940932Medicaid