Provider Demographics
NPI:1184236549
Name:CLINICAL UROLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:CLINICAL UROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KOURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-613-0322
Mailing Address - Street 1:713 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1156
Mailing Address - Country:US
Mailing Address - Phone:256-492-4040
Mailing Address - Fax:256-492-4017
Practice Address - Street 1:7063 VETERANS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-5114
Practice Address - Country:US
Practice Address - Phone:256-492-4040
Practice Address - Fax:256-492-4017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL UROLOGY ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-18
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1275823544Medicaid