Provider Demographics
NPI:1558781724
Name:HARTSELLE MED-PEDS
Entity type:Organization
Organization Name:HARTSELLE MED-PEDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:S
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-973-2150
Mailing Address - Street 1:301 PINE ST NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2338
Mailing Address - Country:US
Mailing Address - Phone:256-773-8898
Mailing Address - Fax:256-773-5583
Practice Address - Street 1:301 PINE ST NW
Practice Address - Street 2:SUITE D
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2338
Practice Address - Country:US
Practice Address - Phone:256-773-8898
Practice Address - Fax:256-773-5583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR MORGAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-25
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty