Provider Demographics
NPI:1154750073
Name:COMMUNITY URGENT CARE OF HARTSELLE, INC.
Entity type:Organization
Organization Name:COMMUNITY URGENT CARE OF HARTSELLE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:OREL
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:256-734-2977
Mailing Address - Street 1:101 1ST AVE NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2967
Mailing Address - Country:US
Mailing Address - Phone:256-734-2977
Mailing Address - Fax:888-298-8524
Practice Address - Street 1:1635 HIGHWAY 31 NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-4426
Practice Address - Country:US
Practice Address - Phone:256-773-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty