Provider Demographics
NPI:1619920519
Name:CULLMAN INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:CULLMAN INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:PEINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-737-8000
Mailing Address - Street 1:1890 AL HIGHWAY 157
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3601
Mailing Address - Country:US
Mailing Address - Phone:256-737-8000
Mailing Address - Fax:256-737-8058
Practice Address - Street 1:1890 AL HIGHWAY 157
Practice Address - Street 2:SUITE 300
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3601
Practice Address - Country:US
Practice Address - Phone:256-737-8000
Practice Address - Fax:256-737-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCD0005OtherRAILROAD MEDICARE
AL541003846Medicaid
AL528301990Medicaid
AL013846Medicare Oscar/Certification
ALD536Medicare ID - Type UnspecifiedGROUP NUMBER
ALK357Medicare PIN
ALI457Medicare PIN