Provider Demographics
NPI:1467401208
Name:HARTSELLES EMERGENCY SERVICES, LLC
Entity Type:Organization
Organization Name:HARTSELLES EMERGENCY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-768-4392
Mailing Address - Street 1:6400 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JAX
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8768
Mailing Address - Country:US
Mailing Address - Phone:866-638-5931
Mailing Address - Fax:904-805-1456
Practice Address - Street 1:201 PINE ST NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2309
Practice Address - Country:US
Practice Address - Phone:256-751-3000
Practice Address - Fax:904-805-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTRICARE GROUP TAX ID#
ALK217Medicare ID - Type UnspecifiedMEDICARE GROUP #