Provider Demographics
NPI:1588686505
Name:JASPER URGENT CARE
Entity type:Organization
Organization Name:JASPER URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOLANLE
Authorized Official - Middle Name:O
Authorized Official - Last Name:GBADEBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-295-0002
Mailing Address - Street 1:4330 78 EAST #115
Mailing Address - Street 2:MEDICAL PLAZA SUITE 115
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8955
Mailing Address - Country:US
Mailing Address - Phone:205-295-0002
Mailing Address - Fax:205-295-0991
Practice Address - Street 1:4330 78 EAST #115
Practice Address - Street 2:MEDICAL PLAZA EAST SUITE 115
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8955
Practice Address - Country:US
Practice Address - Phone:205-295-0002
Practice Address - Fax:205-295-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529929710Medicaid
AL529929710Medicaid