Provider Demographics
NPI:1629667837
Name:CULLMAN PAIN AND WELLNESS LLC
Entity Type:Organization
Organization Name:CULLMAN PAIN AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-608-8199
Mailing Address - Street 1:1701 MAIN AVE SW STE E
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5385
Mailing Address - Country:US
Mailing Address - Phone:256-737-4100
Mailing Address - Fax:
Practice Address - Street 1:1701 MAIN AVE SW STE E
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5385
Practice Address - Country:US
Practice Address - Phone:256-737-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDO1004OtherSTATE LICENSE