Provider Demographics
NPI:1730501842
Name:RIVERCHASE URGENT CARE
Entity Type:Organization
Organization Name:RIVERCHASE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PAYSON
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-999-8583
Mailing Address - Street 1:1924 HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1141
Mailing Address - Country:US
Mailing Address - Phone:205-988-3715
Mailing Address - Fax:205-988-3716
Practice Address - Street 1:1926 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1141
Practice Address - Country:US
Practice Address - Phone:205-999-8583
Practice Address - Fax:205-314-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty