Provider Demographics
NPI:1497025878
Name:UROLOGY SOUTH PC
Entity Type:Organization
Organization Name:UROLOGY SOUTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-663-4638
Mailing Address - Street 1:1004 1ST ST N
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8766
Mailing Address - Country:US
Mailing Address - Phone:205-663-4638
Mailing Address - Fax:205-620-5209
Practice Address - Street 1:1004 1ST ST N
Practice Address - Street 2:SUITE 320
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8766
Practice Address - Country:US
Practice Address - Phone:205-663-4638
Practice Address - Fax:205-620-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12520208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060884Medicare UPIN