Provider Demographics
NPI:1003027079
Name:UROLOGY SPECIALISTS, PC
Entity type:Organization
Organization Name:UROLOGY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JIMINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-882-3605
Mailing Address - Street 1:UROLOGY SPECIALISTS, PC
Mailing Address - Street 2:4704 WHITESBURG DR. SUITE 100
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802
Mailing Address - Country:US
Mailing Address - Phone:256-882-3603
Mailing Address - Fax:256-882-9323
Practice Address - Street 1:4704 WHITESBURG DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1631
Practice Address - Country:US
Practice Address - Phone:256-882-3605
Practice Address - Fax:256-882-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013315208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76418Medicare UPIN
ALC76426Medicare UPIN
ALH38132Medicare UPIN
ALE75372Medicare UPIN