Provider Demographics
NPI:1316053515
Name:HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC
Entity type:Organization
Organization Name:HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELQUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-502-4712
Mailing Address - Street 1:PO BOX 10327
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-0327
Mailing Address - Country:US
Mailing Address - Phone:205-502-4712
Mailing Address - Fax:205-502-4710
Practice Address - Street 1:1528 CARRAWAY BLVD
Practice Address - Street 2:ATTN: RADIATION ONCOLOGY DEPARTMENT
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35234-1998
Practice Address - Country:US
Practice Address - Phone:205-502-4020
Practice Address - Fax:205-502-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCK5459OtherRAILROAD MEDICARE
ALJ364Medicare ID - Type UnspecifiedFACILITY CODE