Basic Information
| Provider Information | |||||||||
| NPI: | 1356866693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICAL 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 | ||||||||
| FaxNumber: | 2564924017 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 COUNTY ROAD 407 | ||||||||
| Address2: | |||||||||
| City: | CENTRE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359606759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564924040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2017 | ||||||||
| LastUpdateDate: | 09/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | JANSS | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2564924040 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLINICAL UROLOGY ASSOCIATES, P.C. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.