Provider Demographics
NPI:1841420049
Name:NORTHEAST ALABAMA UROLOGY CENTER, P.C.
Entity Type:Organization
Organization Name:NORTHEAST ALABAMA UROLOGY CENTER, P.C.
Other - Org Name:ROSEN UROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-435-1871
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-0339
Mailing Address - Country:US
Mailing Address - Phone:256-435-1871
Mailing Address - Fax:256-435-5703
Practice Address - Street 1:201 HENRY RD SW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3324
Practice Address - Country:US
Practice Address - Phone:256-435-1871
Practice Address - Fax:256-435-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12000261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76499Medicare UPIN
AL1050500001Medicare NSC