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Organization
FULTONDALE URGENT CARE LLC
Active
Organization
FULTONDALE URGENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG RANDALL (COO)
(205) 841-2844
Entity
Organization
Contact information
Practice address
339 WALKER CHAPEL PLZ, SUITE 115, FULTONDALE, AL 35068-3401
(205) 841-2844
Mailing address
339 WALKER CHAPEL PLZ, SUITE 115, FULTONDALE, AL 35068-3401
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
NULL
207P00000X
Emergency Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0CXJ1
BCBS
AL
01
—
1659697696
TRICARE SOUTH
AL
05
—
169110
—
AL
01
—
615236400
DOL
—
01
—
DQ4012
RRMC
AL
Enumeration date
02/27/2015
Last updated
03/02/2015
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