Provider Demographics
NPI:1164434536
Name:DRS. COULTER, MCROY & ASSOCIATES PC
Entity Type:Organization
Organization Name:DRS. COULTER, MCROY & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:MCROY
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:256-880-8058
Mailing Address - Street 1:8200 WHITESBURG DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802
Mailing Address - Country:US
Mailing Address - Phone:256-880-8058
Mailing Address - Fax:256-880-1277
Practice Address - Street 1:8200 WHITESBURG DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:256-880-8058
Practice Address - Fax:256-880-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-847-TA-353152W00000X
ALS-595-TA-298152W00000X
ALR151TA719152W00000X
ALS595 TA 298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529603830Medicaid
AL529603830Medicaid