Provider Demographics
NPI:1457431736
Name:ACCULAB INC.
Entity Type:Organization
Organization Name:ACCULAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-739-9778
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0190
Mailing Address - Country:US
Mailing Address - Phone:256-739-9778
Mailing Address - Fax:256-739-9196
Practice Address - Street 1:401 ARNOLD ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1919
Practice Address - Country:US
Practice Address - Phone:256-739-9778
Practice Address - Fax:256-739-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000056504Medicaid
AL000056504Medicare ID - Type Unspecified