Provider Demographics
NPI:1942277124
Name:HEALTH CARE AUTHORITY OF CULLMAN
Entity Type:Organization
Organization Name:HEALTH CARE AUTHORITY OF CULLMAN
Other - Org Name:CULLMAN EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-737-2595
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-1250
Mailing Address - Country:US
Mailing Address - Phone:256-734-1584
Mailing Address - Fax:256-737-0314
Practice Address - Street 1:601 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-4218
Practice Address - Country:US
Practice Address - Phone:256-734-1584
Practice Address - Fax:256-737-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL195341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000050422Medicaid
AL000050422Medicaid