Healthcare Provider Details

I. General information

NPI: 1316112568
Provider Name (Legal Business Name): CULLMAN REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MAIN ST SW
HANCEVILLE AL
35077-5476
US

IV. Provider business mailing address

503 CLARK ST NE
CULLMAN AL
35055-1921
US

V. Phone/Fax

Practice location:
  • Phone: 256-352-0188
  • Fax: 256-352-0187
Mailing address:
  • Phone: 256-739-1759
  • Fax: 256-739-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberH2201
License Number StateAL

VIII. Authorized Official

Name: JETE EDMISSON
Title or Position: CFO
Credential:
Phone: 256-737-2598