Provider Demographics
NPI:1629482302
Name:HARTSELLE FAMILY PRACTICE
Entity Type:Organization
Organization Name:HARTSELLE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:DARCELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-341-2802
Mailing Address - Street 1:1211 HIGHWAY 31 NW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-4420
Mailing Address - Country:US
Mailing Address - Phone:256-773-6017
Mailing Address - Fax:256-773-7834
Practice Address - Street 1:1211 HIGHWAY 31 NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-4420
Practice Address - Country:US
Practice Address - Phone:256-773-6017
Practice Address - Fax:256-773-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty