Provider Demographics
NPI:1245202944
Name:UROLOGICAL ASSOCIATES OF DOTHAN,P.A.
Entity Type:Organization
Organization Name:UROLOGICAL ASSOCIATES OF DOTHAN,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-794-4159
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-794-4159
Mailing Address - Fax:334-792-7019
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 500
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-794-4159
Practice Address - Fax:334-792-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H113Medicare ID - Type UnspecifiedFLS OFFICE PAYEE
C047Medicare ID - Type UnspecifiedMC OFFICE PAYEE