1164407151 NPI number — MOBILE UROLOGY GROUP, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164407151 NPI number — MOBILE UROLOGY GROUP, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE UROLOGY GROUP, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164407151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MEMORIAL HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-343-9090
Provider Business Mailing Address Fax Number:
251-380-1015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MEMORIAL HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-343-9090
Provider Business Practice Location Address Fax Number:
251-380-1015
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FLECK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
251-343-9090

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0635230001 . This is a "DMERC JURISDICTION C" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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