Provider Demographics
NPI:1275595183
Name:CULLMAN UROLOGY, P C
Entity Type:Organization
Organization Name:CULLMAN UROLOGY, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-739-2885
Mailing Address - Street 1:1848 PARKLAND DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058
Mailing Address - Country:US
Mailing Address - Phone:256-739-2885
Mailing Address - Fax:256-739-2898
Practice Address - Street 1:1848 PARKLAND DRIVE NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058
Practice Address - Country:US
Practice Address - Phone:256-739-2885
Practice Address - Fax:256-739-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529302990Medicaid
ALD472OtherBC-BS OF ALABAMA GROUP #
ALE642Medicare ID - Type UnspecifiedALABAMA MEDICARE GROUP #
AL529302990Medicaid
ALD472Medicare ID - Type UnspecifiedALABAMA MEDICARE GROUP #