Healthcare Provider Details

I. General information

NPI: 1447085089
Provider Name (Legal Business Name): HURTSBORO ADULT AND PEDIATRIC MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MAIN STREET
HURTSBORO AL
36860
US

IV. Provider business mailing address

733 ANNABROOK DR
AUBURN AL
36830-7529
US

V. Phone/Fax

Practice location:
  • Phone: 334-232-6551
  • Fax: 334-384-9923
Mailing address:
  • Phone: 334-332-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA BAKER
Title or Position: SOLE MEMBER
Credential: NP
Phone: 334-332-9130