Organization
CULLMAN PRIMARY CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEN G BOSTICK M.D. (SUPERVISING PHYSICIAN)
(256) 734-3141
Entity
Organization
Contact information
Practice address
105 2ND AVE SE, CULLMAN, AL 35055-3511
(256) 734-3141
(256) 734-3866
Mailing address
503 CLARK ST NE, CULLMAN, AL 35055-1921
(256) 739-1759
(256) 739-0027
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
Primary
01D0300133
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000040933
MEDICARE GROUP ID
AL
05
—
000040933
—
AL
Enumeration date
11/07/2005
Last updated
08/31/2023
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