Healthcare Provider Details

I. General information

NPI: 1174579213
Provider Name (Legal Business Name): LISTER HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104A PHYSICIANS DR
MUSCLE SHOALS AL
35661-2100
US

IV. Provider business mailing address

PO BOX 298
FLORENCE AL
35631-0298
US

V. Phone/Fax

Practice location:
  • Phone: 256-383-6070
  • Fax: 256-381-4022
Mailing address:
  • Phone: 256-767-7494
  • Fax: 256-760-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTA CHASE
Title or Position: CREDENTIALING
Credential:
Phone: 256-767-7494