Provider Demographics
NPI:1558533166
Name:CULLMAN REGIONAL MEDICAL CENTER PHYSICIANS
Entity Type:Organization
Organization Name:CULLMAN REGIONAL MEDICAL CENTER PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:JETE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-737-2598
Mailing Address - Street 1:1912 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0609
Mailing Address - Country:US
Mailing Address - Phone:256-737-2000
Mailing Address - Fax:256-737-2005
Practice Address - Street 1:1912 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-737-2000
Practice Address - Fax:256-737-2005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULLMAN REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10337282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529920900Medicaid