Basic Information
| Provider Information | |||||||||
| NPI: | 1336363001 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CILINICAL UROLOGY ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 GOODYEAR AVE | ||||||||
| Address2: | |||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359031156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564924040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 US HIGHWAY 431 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOAZ | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359575934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565938633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 09/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | PIRANI | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 2564924040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLINICAL UROLOGY ASSOCIATES, P.C. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 000042853 | 01 | DR. CHESTER HICKS BCBS | OTHER | 051509377 | 01 | DR. MANISH SHAH BCBS | OTHER | 051534775 | 01 | DR. MERLE WADE BCBS | OTHER | 000068391 | 01 | AL | DR. JOHN PIRANI BCBS | OTHER | 000068391 | 05 | AL | MEDICAID | 000060243 | 05 | AL | MEDICAID |