Provider Demographics
NPI:1215337118
Name:HOMETOWN PEDIATRICS OF JOPLIN
Entity type:Organization
Organization Name:HOMETOWN PEDIATRICS OF JOPLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-626-7337
Mailing Address - Street 1:2302 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4301
Mailing Address - Country:US
Mailing Address - Phone:417-626-7337
Mailing Address - Fax:
Practice Address - Street 1:200 CASTLE DR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-9115
Practice Address - Country:US
Practice Address - Phone:141-762-6733
Practice Address - Fax:417-626-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100303350BMedicaid
MO248898710Medicaid
G60034Medicare UPIN