| Name: | Cullman Surgical Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Aug 1997 (27 years ago) |
| Entity Number: | 000-188-846 |
| Register Number: | 000188846 |
| County: | Cullman |
| Place of Formation: | Cullman County |
| Principal Address: | CULLMAN, AL |
| Registered Office Street Address: | 1948 ALABAMA HWY 157 STE 250CULLMAN, AL 35058 |
| Registered Office Street Address ZIP Code: | 35058 |
| Authorized Capital: | $100 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467603597 | 2008-10-07 | 2016-09-12 | 212 4TH AVE SE, SUITE 100, CULLMAN, AL, 350553673, US | 212 4TH AVE SE, SUITE 100, CULLMAN, AL, 350553673, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-739-6050 |
| Fax | 2567394921 |
Authorized person
| Name | DR. DONALD RAY MARECLE |
| Role | PRESIDENT |
| Phone | 2567396050 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | 9759 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | 000035588 |
| Issuer | BLUE CROSS/BLUE SHIELD OF ALABAMA |
| Number | 051035588 |
| Issuer | MEDICAID |
| Number | 000035588 |
| State | AL |
| Name | Role |
|---|---|
| MARCELE, DONALD R | Incorporator |
| Name | Role |
|---|---|
| MARECLE, DONALD R | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
