Healthcare Provider Details

I. General information

NPI: 1457431736
Provider Name (Legal Business Name): ACCULAB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ARNOLD ST NE
CULLMAN AL
35055-1919
US

IV. Provider business mailing address

PO BOX 190
CULLMAN AL
35056-0190
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-9778
  • Fax: 256-739-9196
Mailing address:
  • Phone: 256-739-9778
  • Fax: 256-739-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier000056504
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name: MRS. KANDY WIDNER
Title or Position: GENERAL MANAGER
Credential:
Phone: 256-739-9778