Provider Demographics
NPI:1225197197
Name:WEST ALABAMA NEPHROLOGY, PC
Entity type:Organization
Organization Name:WEST ALABAMA NEPHROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALILONU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-345-6302
Mailing Address - Street 1:4400 WATERMELON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5204
Mailing Address - Country:US
Mailing Address - Phone:205-345-6302
Mailing Address - Fax:205-247-4300
Practice Address - Street 1:4400 WATERMELON RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5204
Practice Address - Country:US
Practice Address - Phone:205-345-6302
Practice Address - Fax:205-247-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL103380Medicaid
AL28996OtherAL LICENSE
AL51591962OtherBCBS NUMBER
AL000037267Medicaid
AL51037267OtherBCBS
AL529603880Medicaid
AL9748OtherAL LICENSE
AL28996OtherAL LICENSE
AL9748OtherAL LICENSE
AL529603880Medicaid