MEDICARE: SHOALS UROLOGICAL ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	22634	AL

General Provider Information

NPI Number	:	1063579787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOALS UROLOGICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	1015 S JACKSON HWY
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-5760
Country	:	US
Telephone Number	:	256-381-5510
Fax Number	:	256-386-5551

Provider Business Practice Location Address
First Line	:	1015 S JACKSON HWY
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-5760
Country	:	US
Telephone Number	:	256-381-5510
Fax Number	:	256-386-5551

Authorized Official
Title or Position	:	INSURANCE MANAGER
Name	:	MRS. DEANNA M LONGMIRE
Credential	:
Telephone Number	:	256-381-5510

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	10/15/2007

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