Healthcare Provider Details

I. General information

NPI: 1588752844
Provider Name (Legal Business Name): ELBERTA CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24980 STATE ST PO DRAWER 519
ELBERTA AL
36530-2573
US

IV. Provider business mailing address

24980 STATE ST PO DRAWER 519
ELBERTA AL
36530-2573
US

V. Phone/Fax

Practice location:
  • Phone: 251-986-7301
  • Fax: 251-986-5927
Mailing address:
  • Phone: 251-986-7301
  • Fax: 251-986-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY A. KURTTS
Title or Position: OWNER
Credential: M.D.
Phone: 251-986-7301