Provider Demographics
NPI:1649553520
Name:HRT LLC
Entity type:Organization
Organization Name:HRT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-490-9421
Mailing Address - Street 1:1423 GADSDEN HWY
Mailing Address - Street 2:115
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3152
Mailing Address - Country:US
Mailing Address - Phone:256-413-3241
Mailing Address - Fax:256-413-3241
Practice Address - Street 1:1423 GADSDEN HWY
Practice Address - Street 2:115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3152
Practice Address - Country:US
Practice Address - Phone:256-413-3241
Practice Address - Fax:256-413-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty