Healthcare Provider Details

I. General information

NPI: 1891057543
Provider Name (Legal Business Name): QBR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 SQUIRE RUN
ATHENS AL
35613-2032
US

IV. Provider business mailing address

PO BOX 6289
HUNTSVILLE AL
35813-0289
US

V. Phone/Fax

Practice location:
  • Phone: 256-489-5273
  • Fax: 334-460-9432
Mailing address:
  • Phone: 256-489-5273
  • Fax: 334-460-9432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number09094
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number09094
License Number StateAL

VIII. Authorized Official

Name: JOHN HORNBUCKLE
Title or Position: PRESIDENT
Credential:
Phone: 256-489-5273