MEDICARE: URGENT CARE OF RUSSELLVILLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1639406416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT CARE OF RUSSELLVILLE, LLC

Provider Business Mailing Address
First Line	:	13150 HIGHWAY 43
Second Line	:	SUITE 10
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-4558
Country	:	US
Telephone Number	:	256-331-2092
Fax Number	:	256-331-2096

Provider Business Practice Location Address
First Line	:	13150 HIGHWAY 43
Second Line	:	SUITE 10
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-4558
Country	:	US
Telephone Number	:	256-331-2092
Fax Number	:	256-331-2096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANDALL SPRADLIN
Credential	:
Telephone Number	:	205-665-7001

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	11/16/2009

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