Basic Information
| Provider Information | |||||||||
| NPI: | 1194057554 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WETUMPKA URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 CAMBRIDGE DRIVE | ||||||||
| Address2: | |||||||||
| City: | WETUMPKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345678633 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 CAMBRIDGE DRIVE | ||||||||
| Address2: | |||||||||
| City: | WETUMPKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345678633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2010 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRUCE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3345674311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.