1730795261 NPI number — HOMETOWN URGENT CARE

Table of content: (NPI 1730795261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730795261 NPI number — HOMETOWN URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMETOWN URGENT CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730795261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1540 S US HIGHWAY 421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLAN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40831-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-573-9939
Provider Business Mailing Address Fax Number:
606-573-9940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 SOUTH U.S. HWY 421 BY-PASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-9939
Provider Business Practice Location Address Fax Number:
606-573-9940
Provider Enumeration Date:
09/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
COLDIRON
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-273-1251

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100705870 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com