Provider Demographics
NPI:1164625968
Name:CORRECTIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:CORRECTIONAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DELANO
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-467-6111
Mailing Address - Street 1:528 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1405
Mailing Address - Country:US
Mailing Address - Phone:850-255-4927
Mailing Address - Fax:205-467-6738
Practice Address - Street 1:1000 SAINT CLAIR RD
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-5582
Practice Address - Country:US
Practice Address - Phone:205-467-6111
Practice Address - Fax:205-467-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24889261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health