Healthcare Provider Details

I. General information

NPI: 1194057554
Provider Name (Legal Business Name): WETUMPKA URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CAMBRIDGE DRIVE
WETUMPKA AL
36093
US

IV. Provider business mailing address

11 CAMBRIDGE DRIVE
WETUMPKA AL
36093
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-8633
  • Fax:
Mailing address:
  • Phone: 334-567-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D BRUCE
Title or Position: CEO
Credential:
Phone: 334-567-4311