Provider Demographics
NPI:1770642936
Name:UROLOGY ASSOCIATES OF WEST ALABAMA LLC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF WEST ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-344-9393
Mailing Address - Street 1:PO BOX 403643
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3643
Mailing Address - Country:US
Mailing Address - Phone:800-647-6889
Mailing Address - Fax:615-261-6052
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:STE 908
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-344-9393
Practice Address - Fax:205-758-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000740208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0383440001Medicare NSC
AL=========Medicare NSC