1730320748 NPI number — HARTSELLE PHYSICIANS, INC.

Table of content: (NPI 1730320748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730320748 NPI number — HARTSELLE PHYSICIANS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARTSELLE PHYSICIANS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARTSELLE PHYSICIANS INC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730320748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 CORPORATE CENTRE DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-2659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-764-3000
Provider Business Mailing Address Fax Number:
615-764-3030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 PINE ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSELLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35640-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-751-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SLIPKOVICH
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-764-3000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD.30368 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)