Provider Demographics
NPI:1962146571
Name:HOMETOWN PRIMARY CARE OF FRANKFORT PLLC
Entity type:Organization
Organization Name:HOMETOWN PRIMARY CARE OF FRANKFORT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHIME
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIERE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:708-847-8688
Mailing Address - Street 1:10205 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1279
Mailing Address - Country:US
Mailing Address - Phone:708-998-2979
Mailing Address - Fax:
Practice Address - Street 1:10205 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1279
Practice Address - Country:US
Practice Address - Phone:708-998-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL332781777001Medicaid