Provider Demographics
NPI:1215958103
Name:AFTER HOURS CLINIC INC
Entity type:Organization
Organization Name:AFTER HOURS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-384-4585
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-1287
Mailing Address - Country:US
Mailing Address - Phone:205-384-4585
Mailing Address - Fax:205-384-4428
Practice Address - Street 1:1800 BIRMINGHAM AVENUE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501
Practice Address - Country:US
Practice Address - Phone:205-384-4585
Practice Address - Fax:205-384-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C71946Medicare UPIN
C72345Medicare UPIN
H13448Medicare UPIN