Provider Demographics
NPI:1346205341
Name:ALABAMA UROLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ALABAMA UROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-877-2860
Mailing Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:ACC - SUITE 305
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6808
Mailing Address - Country:US
Mailing Address - Phone:205-877-2860
Mailing Address - Fax:205-877-2733
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 305
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-877-2860
Practice Address - Fax:205-877-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000024112Medicaid
AL000004393Medicaid
ALC76527Medicare UPIN
ALG06161Medicare UPIN
AL000004393Medicare ID - Type Unspecified
AL000024112Medicaid
AL000024112Medicare ID - Type Unspecified