Provider Demographics
NPI:1689734725
Name:ALEXANDRIA UROLOGY ASSOCIATES LLP
Entity Type:Organization
Organization Name:ALEXANDRIA UROLOGY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEMPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-473-2169
Mailing Address - Street 1:1201 N. BOLTON
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-473-2169
Mailing Address - Fax:318-487-8447
Practice Address - Street 1:301 4TH ST # 30133
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8423
Practice Address - Country:US
Practice Address - Phone:318-473-2169
Practice Address - Fax:318-487-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944530Medicaid
LA0280850001OtherCIGNA-GOVERNMENT
LA5D816Medicare PIN