Provider Demographics
NPI:1730292228
Name:HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC
Entity Type:Organization
Organization Name:HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELQUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-271-8541
Mailing Address - Street 1:PO BOX 131329
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-6329
Mailing Address - Country:US
Mailing Address - Phone:205-271-8541
Mailing Address - Fax:205-271-8555
Practice Address - Street 1:705 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1156
Practice Address - Country:US
Practice Address - Phone:256-492-0375
Practice Address - Fax:256-492-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCK5459OtherRAILROAD MEDICARE
AL529931810Medicaid
ALE812Medicare PIN