Provider Demographics
NPI:1285409557
Name:CILINICAL UROLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:CILINICAL UROLOGY ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
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:256-492-4040
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 1:2110 GLENN BLVD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3527
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:2023-11-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty