Provider Demographics
NPI:1881991131
Name:HOMETOWN FAMILY MEDICINE PS
Entity type:Organization
Organization Name:HOMETOWN FAMILY MEDICINE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SACKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-659-4800
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:210 W. MAIN
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169
Mailing Address - Country:US
Mailing Address - Phone:509-659-4800
Mailing Address - Fax:509-659-4801
Practice Address - Street 1:210 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-1410
Practice Address - Country:US
Practice Address - Phone:509-659-4800
Practice Address - Fax:509-659-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care