Healthcare Provider Details

I. General information

NPI: 1639406416
Provider Name (Legal Business Name): URGENT CARE OF RUSSELLVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 HIGHWAY 43 SUITE 10
RUSSELLVILLE AL
35653-4558
US

IV. Provider business mailing address

13150 HIGHWAY 43 SUITE 10
RUSSELLVILLE AL
35653-4558
US

V. Phone/Fax

Practice location:
  • Phone: 256-331-2092
  • Fax: 256-331-2096
Mailing address:
  • Phone: 256-331-2092
  • Fax: 256-331-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RANDALL SPRADLIN
Title or Position: PRESIDENT
Credential:
Phone: 205-665-7001