Provider Demographics
NPI:1609806306
Name:LISTER HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:LISTER HEALTH CARE CORPORATION
Other - Org Name:CALERA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-767-7494
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-1450
Mailing Address - Country:US
Mailing Address - Phone:800-763-0941
Mailing Address - Fax:205-668-3570
Practice Address - Street 1:11206 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-6814
Practice Address - Country:US
Practice Address - Phone:800-763-0941
Practice Address - Fax:205-668-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI067Medicare ID - Type Unspecified