Provider Demographics
NPI:1417161456
Name:ANNISTON UROLOGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ANNISTON UROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-237-6717
Mailing Address - Street 1:622 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5744
Mailing Address - Country:US
Mailing Address - Phone:256-237-6717
Mailing Address - Fax:
Practice Address - Street 1:622 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5744
Practice Address - Country:US
Practice Address - Phone:256-237-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCL4963OtherRAILROAD MEDICARE
ALD430Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER