Healthcare Provider Details

I. General information

NPI: 1669974135
Provider Name (Legal Business Name): CULLMAN REGIONAL MEDICAL CENTER , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 AL HWY 157
CULLMAN AL
35058
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 256-737-2000
  • Fax: 256-737-2050
Mailing address:
  • Phone: 256-737-2081
  • Fax: 256-737-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier218008
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name: MS. NESHA DONALDSON
Title or Position: CFO
Credential:
Phone: 256-737-2598