Provider Demographics
NPI:1417912957
Name:UROLOGY CLINIC, LLC
Entity Type:Organization
Organization Name:UROLOGY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-427-7218
Mailing Address - Street 1:215 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5311
Mailing Address - Country:US
Mailing Address - Phone:334-427-7218
Mailing Address - Fax:334-427-4999
Practice Address - Street 1:215 MEDICAL PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5311
Practice Address - Country:US
Practice Address - Phone:334-427-7218
Practice Address - Fax:334-427-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty