1841420049 NPI number — NORTHEAST ALABAMA UROLOGY CENTER, P.C.

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 1841420049 NPI number — NORTHEAST ALABAMA UROLOGY CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST ALABAMA UROLOGY CENTER, P.C.
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:
6
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:
1841420049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36265-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-435-1871
Provider Business Mailing Address Fax Number:
256-435-5703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HENRY RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36265-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-435-1871
Provider Business Practice Location Address Fax Number:
256-435-5703
Provider Enumeration Date:
07/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEN
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
STANLEY
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
256-435-1871

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  12000 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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