Provider Demographics
NPI:1184669483
Name:CRADDOCK HEALTH CENTER P C
Entity Type:Organization
Organization Name:CRADDOCK HEALTH CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-245-5241
Mailing Address - Street 1:209 W SPRING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2973
Mailing Address - Country:US
Mailing Address - Phone:256-245-5241
Mailing Address - Fax:256-245-0194
Practice Address - Street 1:209 W SPRING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2973
Practice Address - Country:US
Practice Address - Phone:256-245-5241
Practice Address - Fax:256-245-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty