Provider Demographics
NPI:1649334301
Name:CULLMAN HEART & URGENT CARE PC
Entity type:Organization
Organization Name:CULLMAN HEART & URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:KWON
Authorized Official - Last Name:VARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-775-6550
Mailing Address - Street 1:1801 PARKVIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3618
Mailing Address - Country:US
Mailing Address - Phone:256-775-6550
Mailing Address - Fax:256-775-6772
Practice Address - Street 1:1801 PARKVIEW DR NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3618
Practice Address - Country:US
Practice Address - Phone:256-775-6550
Practice Address - Fax:256-775-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51007426OtherBLUE CROSS & BLUE SHIELD
AL51029544OtherBLUE CROSS & BLUE SHIELD
AL51542451OtherBLUE CROSS & BLUE SHIELD
AL51007299OtherBLUE CROSS & BLUE SHIELD
AL51542451OtherBLUE CROSS & BLUE SHIELD