Provider Demographics
NPI:1437981172
Name:LISTER HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:LISTER HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING AGENT
Authorized Official - Phone:256-366-6841
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0298
Mailing Address - Country:US
Mailing Address - Phone:256-767-7494
Mailing Address - Fax:256-381-9019
Practice Address - Street 1:102 PHYSICIANS DR STE C
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2149
Practice Address - Country:US
Practice Address - Phone:938-216-6007
Practice Address - Fax:256-768-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty