Provider Demographics
NPI:1376699546
Name:SOUTHEAST UROLOGY NETWORK PC
Entity Type:Organization
Organization Name:SOUTHEAST UROLOGY NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ALABASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-527-7100
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0756
Mailing Address - Country:US
Mailing Address - Phone:901-527-7100
Mailing Address - Fax:901-527-7124
Practice Address - Street 1:7420 GUTHRIE DR N
Practice Address - Street 2:STE. 111
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5876
Practice Address - Country:US
Practice Address - Phone:662-349-2220
Practice Address - Fax:662-349-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1060160002Medicare NSC
MSC02076Medicare ID - Type UnspecifiedMISSISSIPPI MEDICARE