Provider Demographics
NPI:1912486937
Name:CEDAR STREET PRIMARY CARE INC.
Entity Type:Organization
Organization Name:CEDAR STREET PRIMARY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEB
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:HORNSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-292-7410
Mailing Address - Street 1:214 HIGHWAY 31 NW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-4445
Mailing Address - Country:US
Mailing Address - Phone:256-292-7410
Mailing Address - Fax:256-502-9879
Practice Address - Street 1:220 CEDAR ST NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640
Practice Address - Country:US
Practice Address - Phone:256-773-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty