Provider Demographics
NPI:1821363524
Name:DALE MEDICAL CENTER
Entity Type:Organization
Organization Name:DALE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:334-774-2601
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-0863
Mailing Address - Country:US
Mailing Address - Phone:334-443-0400
Mailing Address - Fax:334-443-0402
Practice Address - Street 1:320 WHITE AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-0908
Practice Address - Country:US
Practice Address - Phone:334-443-0400
Practice Address - Fax:334-443-0402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARK MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-13
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty