Provider Demographics
NPI:1962840728
Name:URGENT CARE OF ALABAMA LLC
Entity Type:Organization
Organization Name:URGENT CARE OF ALABAMA LLC
Other - Org Name:GARDENDALE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LASKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-515-0538
Mailing Address - Street 1:1355 MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-4201
Mailing Address - Country:US
Mailing Address - Phone:205-285-8252
Mailing Address - Fax:205-285-8262
Practice Address - Street 1:210 FIELDSTOWN RD
Practice Address - Street 2:SUITE 124
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2408
Practice Address - Country:US
Practice Address - Phone:205-285-8252
Practice Address - Fax:205-285-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL628-013207P00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty