Provider Demographics
NPI:1730320748
Name:HARTSELLE PHYSICIANS, INC.
Entity Type:Organization
Organization Name:HARTSELLE PHYSICIANS, INC.
Other - Org Name:HARTSELLE PHYSICIANS INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLIPKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-764-3000
Mailing Address - Street 1:501 CORPORATE CENTRE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2659
Mailing Address - Country:US
Mailing Address - Phone:615-764-3000
Mailing Address - Fax:615-764-3030
Practice Address - Street 1:310 PINE ST NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2316
Practice Address - Country:US
Practice Address - Phone:256-751-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30368207Q00000X
207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty