Provider Demographics
NPI:1881094209
Name:COMMUNITY URGENT CARE OF MADISON, INC.
Entity type:Organization
Organization Name:COMMUNITY URGENT CARE OF MADISON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:205-443-2559
Mailing Address - Street 1:101 1ST AVE NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2967
Mailing Address - Country:US
Mailing Address - Phone:256-734-2977
Mailing Address - Fax:888-298-8524
Practice Address - Street 1:101 1ST AVE NE
Practice Address - Street 2:SUITE 150
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2967
Practice Address - Country:US
Practice Address - Phone:256-734-2977
Practice Address - Fax:888-298-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Single Specialty