Provider Demographics
NPI:1346946308
Name:ALABAMA DEVELOPMENTAL AND DIAGNOSTIC CLINIC LLC
Entity Type:Organization
Organization Name:ALABAMA DEVELOPMENTAL AND DIAGNOSTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:HULTQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:563-424-0459
Mailing Address - Street 1:105 APPLETON LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 APPLETON LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-4162
Practice Address - Country:US
Practice Address - Phone:563-424-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty