Provider Demographics
NPI:1629346820
Name:REGIONAL MEDICAL CENTER BOARD
Entity Type:Organization
Organization Name:REGIONAL MEDICAL CENTER BOARD
Other - Org Name:ANNISTON UROLOGIC ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
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:256-236-1920
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:256-236-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21107208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000076321Medicare PIN
AL051505694Medicare PIN
AL000023287Medicare PIN