Healthcare Provider Details

I. General information

NPI: 1750472502
Provider Name (Legal Business Name): THOMAS H MULLICAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 AL HIGHWAY 157 CULLMAN REGIONAL ORTHOPEDICS AND SPORTS MEDICINE, P.C.
CULLMAN AL
35058-0609
US

IV. Provider business mailing address

1942 AL HIGHWAY 157 CULLMAN REGIONAL ORTHOPEDICS AND SPORTS MEDICINE, P.C.
CULLMAN AL
35058-0609
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-5115
  • Fax: 256-737-5003
Mailing address:
  • Phone: 256-737-5115
  • Fax: 256-737-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberT1616
License Number StateAL

VII. Legacy identifiers

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

# 1
IdentifierP00368354
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: