Healthcare Provider Details

I. General information

NPI: 1629667837
Provider Name (Legal Business Name): CULLMAN PAIN AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 PARKLAND DR NE
CULLMAN AL
35058-6100
US

IV. Provider business mailing address

1848 PARKLAND DR NE
CULLMAN AL
35058-6100
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-4100
  • Fax:
Mailing address:
  • Phone: 256-737-4100
  • Fax: 256-737-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: RICKY BRIAN TUBBS
Title or Position: OWNER
Credential: DO
Phone: 205-608-8199