Provider Demographics
NPI:1215103783
Name:CULLMAN REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:CULLMAN REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:JETE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-737-2598
Mailing Address - Street 1:503 CLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1921
Mailing Address - Country:US
Mailing Address - Phone:256-737-2000
Mailing Address - Fax:256-737-2050
Practice Address - Street 1:4208 EVA RD
Practice Address - Street 2:
Practice Address - City:EVA
Practice Address - State:AL
Practice Address - Zip Code:35621-7629
Practice Address - Country:US
Practice Address - Phone:256-796-5260
Practice Address - Fax:256-796-4639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULLMAN REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH2201261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC816Medicare PIN
ALI162Medicare PIN
I168Medicare PIN