Provider Demographics
NPI:1033719729
Name:FCI TALLADEGA
Entity Type:Organization
Organization Name:FCI TALLADEGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-315-4127
Mailing Address - Street 1:565 E. RENFROE ROAD
Mailing Address - Street 2:
Mailing Address - City:TELLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160
Mailing Address - Country:US
Mailing Address - Phone:256-315-4127
Mailing Address - Fax:256-315-4390
Practice Address - Street 1:565 E. RENFROE ROAD
Practice Address - Street 2:
Practice Address - City:TELLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160
Practice Address - Country:US
Practice Address - Phone:256-315-4127
Practice Address - Fax:256-315-4390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health