Provider Demographics
NPI:1154430999
Name:UROLOGY AND ONCOLOGY SPECIALISTS P.C.
Entity type:Organization
Organization Name:UROLOGY AND ONCOLOGY SPECIALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLINGWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-414-5665
Mailing Address - Street 1:3719 DAUPHIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1753
Mailing Address - Country:US
Mailing Address - Phone:251-414-5665
Mailing Address - Fax:251-414-5571
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-414-5665
Practice Address - Fax:251-414-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528600100Medicaid
ALE367Medicare PIN
AL528600100Medicaid