Provider Demographics
NPI:1164618039
Name:TUCKIER SURGICAL CLINIC
Entity Type:Organization
Organization Name:TUCKIER SURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-974-2121
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-0815
Mailing Address - Country:US
Mailing Address - Phone:256-974-2121
Mailing Address - Fax:256-974-2120
Practice Address - Street 1:202 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1218
Practice Address - Country:US
Practice Address - Phone:256-974-2121
Practice Address - Fax:256-974-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO539208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty