Provider Demographics
NPI:1326116468
Name:UROLOGIC CLINICS OF NORTH ALABAMA PC
Entity type:Organization
Organization Name:UROLOGIC CLINICS OF NORTH ALABAMA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRABARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-797-8262
Mailing Address - Street 1:121 COVESHIRE PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3150
Mailing Address - Country:US
Mailing Address - Phone:352-398-4276
Mailing Address - Fax:352-291-0087
Practice Address - Street 1:3201 SW 34TH ST STE F
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7439
Practice Address - Country:US
Practice Address - Phone:352-398-4276
Practice Address - Fax:352-291-0087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGIC CLINICS OF NORTH ALABAMA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122960300Medicaid
MO200018019Medicaid
ALDG5071OtherMEDICARE RAILROAD CARRIER
AL000092909Medicaid
AL000092909Medicaid