Healthcare Provider Details

I. General information

NPI: 1649280793
Provider Name (Legal Business Name): LOUIS CLARENCE REMYNSE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 AL HIGHWAY 157 STE 230
CULLMAN AL
35058-0642
US

IV. Provider business mailing address

PO BOX 2895
CULLMAN AL
35056-2895
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-2177
  • Fax: 256-203-8684
Mailing address:
  • Phone: 256-737-2177
  • Fax: 256-203-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301055819
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number042.0012584
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number080172
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036150216
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerLICENSE
# 2
Identifier1021499
Identifier TypeMEDICAID
Identifier StateVT
Identifier Issuer
# 3
IdentifierVN3891
Identifier TypeOTHER
Identifier StateVT
Identifier IssuerCVMC-MEDICARE
# 4
Identifier2750986
Identifier TypeMEDICAID
Identifier StateMI
Identifier Issuer
# 5
IdentifierOVN3891
Identifier TypeOTHER
Identifier StateVT
Identifier IssuerCVMC-MEDICAID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: