Hometown Family Medical Clinic, LLC
Organization Active NPI Family Nurse Practitioner · Palestine, AR
NPI 1962024018 · NPPES record last updated Sep 9, 2020
Key facts
- NPI
- 1962024018
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- HOMETOWN FAMILY MEDICAL CLINIC, LLC
- Practice address
- 411 Main St
Palestine, AR 72372 - Phone
- (870) 270-6935
- Fax
- (949) 655-7844
- NPI assigned
- May 12, 2020
- Organization subpart
- No
Authorized official
- Name
- Sandra Elaine Thorne, FNP-C
- Title
- Owner
- Phone
- (870) 270-6935
Practitioners 2
-
Tiffanie Goff, MSN, APRN, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2190839 | Hometown Family Medical Clinic | Certificate of waiver | Aug 18, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201015003174 | AR | Part B Supplier - Clinic/Group Practice | 6103246988 |
Receives reassigned benefits from 1 practitioner Practice locations: Palestine, AR |
National Provider Directory
Locations
411 Main St
Palestine, AR 72372
Phone (870) 270-6935
411 Main St
Ste B
Palestine, AR 72372
Phone (870) 270-6935
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
411 Main St
Palestine, AR 72372
Mailing address
411 Main St
Palestine, AR 72372
Phone (870) 270-6935
Other names
- Hometown Family Medical Clinic
Other providers in Palestine, AR
- Marilyn Collins
- Natalie Colvin
- Brent Flowers
- Tiffanie Goff
- Jessica Mitchell
- Palestine Family Pharmacy LLC
- Palestine Wheatley School District
- Palestine Wheatley School District
- Rosa Taylor
All providers in Palestine, AR · Family Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.