Provider Demographics
NPI:1093018681
Name:SHELBY-CHILTON HEMATOLOGY AND ONCOLOGY LLC
Entity Type:Organization
Organization Name:SHELBY-CHILTON HEMATOLOGY AND ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BALAGANESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPURALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-358-3321
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-0113
Mailing Address - Country:US
Mailing Address - Phone:205-358-3321
Mailing Address - Fax:205-358-3322
Practice Address - Street 1:644 2ND ST NE STE 202
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8823
Practice Address - Country:US
Practice Address - Phone:205-563-3583
Practice Address - Fax:205-358-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24965207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty