Provider Demographics
NPI:1447499090
Name:SMITH LAKE URGENT CARE, LLC
Entity type:Organization
Organization Name:SMITH LAKE URGENT CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-221-9737
Mailing Address - Street 1:1280 SUMMITT
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-0102
Mailing Address - Country:US
Mailing Address - Phone:205-387-7555
Mailing Address - Fax:205-384-9006
Practice Address - Street 1:6610 CURRY HWY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-5664
Practice Address - Country:US
Practice Address - Phone:205-221-9737
Practice Address - Fax:205-221-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13090207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty