Provider Demographics
NPI:1700256252
Name:COMMUNITY URGENT CARE OF MADISON, INC
Entity Type:Organization
Organization Name:COMMUNITY URGENT CARE OF MADISON, INC
Other - Org Name:COMMUNITY URGENT CARE OF MADISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-230-6130
Mailing Address - Street 1:30694 US HIGHWAY 72 STE E
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-3231
Mailing Address - Country:US
Mailing Address - Phone:256-230-6130
Mailing Address - Fax:
Practice Address - Street 1:30694 HIGHWAY 72
Practice Address - Street 2:SUITE E
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756
Practice Address - Country:US
Practice Address - Phone:256-230-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty