MEDICARE: DECATUR MED-SURG CLINIC, 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	261QU0200X	Urgent Care Clinic/Center	387443	AL

General Provider Information

NPI Number	:	1770592206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECATUR MED-SURG CLINIC, LLC

Provider Business Mailing Address
First Line	:	2828 HIGHWAY 31 S
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-1510
Country	:	US
Telephone Number	:	256-353-2000
Fax Number	:	256-355-3470

Provider Business Practice Location Address
First Line	:	2828 HIGHWAY 31 S
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-1510
Country	:	US
Telephone Number	:	256-353-2000
Fax Number	:	256-355-3470

Authorized Official
Title or Position	:	AMINISTRATOR
Name	:	MR. ANDREW HETRICK
Credential	:
Telephone Number	:	256-353-2000

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/22/2020

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