Healthcare Provider Details

I. General information

NPI: 1215334594
Provider Name (Legal Business Name): CULLMAN REGIONAL NURSE ANESTHETISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 AL HIGHWAY 157
CULLMAN AL
35058-0609
US

IV. Provider business mailing address

7956 VAUGHN RD # 165
MONTGOMERY AL
36116-6625
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-2000
  • Fax:
Mailing address:
  • Phone: 888-316-7491
  • Fax: 334-239-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-051912
License Number StateAL

VIII. Authorized Official

Name: MR. NORMAN RAY BURKETT
Title or Position: PRESIDENT
Credential: CRNA
Phone: 334-396-6930