Provider Demographics
NPI:1114138104
Name:ALABAMA UROLOGY AND ROBOTICS CENTER
Entity Type:Organization
Organization Name:ALABAMA UROLOGY AND ROBOTICS CENTER
Other - Org Name:UROLOGY SPECIALISTS OF DECATUR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-353-0605
Mailing Address - Street 1:1210 14TH AVENUE SOUTH EAST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-353-0605
Mailing Address - Fax:256-353-0618
Practice Address - Street 1:1210 14TH AVENUE SOUTH EAST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601
Practice Address - Country:US
Practice Address - Phone:256-353-0605
Practice Address - Fax:256-353-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20057208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI41208Medicare UPIN
ALG40587Medicare UPIN