=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023353513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE NIGHT OFFICE P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2012
-----------------------------------------------------
Last Update Date | 12/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4198 US HIGHWAY 431 SUITE D
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35950-0238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-503-8281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4198 US HIGHWAY 431 SUITE D
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35950-0238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-503-8281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. ELLEN DRAGSTEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 256-503-8281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 0020153
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------