Basic Information
| Provider Information | |||||||||
| NPI: | 1205484326 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HAMILTON FAMILY URGENT CARE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THRIVE HEALTH URGENT CARE, INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 CLOVERDALE RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356331302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562847706 | ||||||||
| FaxNumber: | 2562847711 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 CLOVERDALE RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356331302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562847706 | ||||||||
| FaxNumber: | 2562847711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2019 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAMILTON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | WESLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2562847706 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 240849 | 05 | AL | MEDICAID |