Provider Demographics
NPI:1134494685
Name:CULLMAN HEART & URGENT CARE PC
Entity Type:Organization
Organization Name:CULLMAN HEART & URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:VARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-775-6550
Mailing Address - Street 1:1801 PARK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3618
Mailing Address - Country:US
Mailing Address - Phone:256-775-6550
Mailing Address - Fax:256-775-6772
Practice Address - Street 1:1803 PARK VIEW DR
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3618
Practice Address - Country:US
Practice Address - Phone:256-255-1900
Practice Address - Fax:256-255-1937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULLMAN HEART & URGENT CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17814208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649334301OtherOTHER GROUP NPI
AL529802590Medicaid
1649334301OtherOTHER GROUP NPI