Provider Demographics
NPI:1235689480
Name:JASPER COUNTY AFTER HOURS URGENT CARE INC
Entity Type:Organization
Organization Name:JASPER COUNTY AFTER HOURS URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:219-866-0485
Mailing Address - Street 1:716 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3083
Mailing Address - Country:US
Mailing Address - Phone:219-866-0485
Mailing Address - Fax:219-866-0837
Practice Address - Street 1:716 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978
Practice Address - Country:US
Practice Address - Phone:219-866-0485
Practice Address - Fax:219-866-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty