Healthcare Provider Details

I. General information

NPI: 1073571709
Provider Name (Legal Business Name): HARTSELLE EMERGENCY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PINE ST NW
HARTSELLE AL
35640-2309
US

IV. Provider business mailing address

PO BOX 863535
ORLANDO FL
32886-3535
US

V. Phone/Fax

Practice location:
  • Phone: 256-751-3000
  • Fax: 904-805-1302
Mailing address:
  • Phone: 904-805-1300
  • Fax: 904-805-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J BUNKER
Title or Position: CHAIRMAN/PRESIDENT/CEO
Credential:
Phone: 904-805-1300