Provider Demographics
NPI:1013356245
Name:SULPHUR UROLOGY LLC
Entity Type:Organization
Organization Name:SULPHUR UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-528-7898
Mailing Address - Street 1:1327 STELLY LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5641
Mailing Address - Country:US
Mailing Address - Phone:337-528-7898
Mailing Address - Fax:337-528-7427
Practice Address - Street 1:1327 STELLY LN
Practice Address - Street 2:SUITE 2
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5641
Practice Address - Country:US
Practice Address - Phone:337-528-7898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD07139R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1361674Medicaid
LA1361674Medicaid