Healthcare Provider Details

I. General information

NPI: 1326507013
Provider Name (Legal Business Name): CULLMAN REGIONAL PAIN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 05/21/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 AL HWY 157
CULLMAN AL
35058-0609
US

IV. Provider business mailing address

P.O. BOX 1108
CULLMAN AL
35056-1108
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-2235
  • Fax: 256-737-2227
Mailing address:
  • Phone: 256-735-5041
  • Fax: 256-735-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NESHA DONALDSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 256-737-2598