Healthcare Provider Details

I. General information

NPI: 1285832733
Provider Name (Legal Business Name): SMITH LAKE URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 CURRY HWY
JASPER AL
35503-5664
US

IV. Provider business mailing address

1280 SUMMIT DR.
JASPER AL
35501-0102
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-7555
  • Fax: 205-387-7551
Mailing address:
  • Phone: 205-387-7555
  • Fax: 205-387-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAN WESTERMAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 205-387-7555