1881797405 NPI number — CULLMAN OB GYN PC

Table of content: (NPI 1881797405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881797405 NPI number — CULLMAN OB GYN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CULLMAN OB GYN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881797405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 AL HWY 157
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-739-2626
Provider Business Mailing Address Fax Number:
256-739-6588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 AL HWY 157
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
CULLMAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-739-2626
Provider Business Practice Location Address Fax Number:
256-739-6588
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
FOSTER
Authorized Official Title or Position:
PHYSICIAN PRESIDENT
Authorized Official Telephone Number:
256-739-2626

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CC0597 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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