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General NPI Number Information
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NPI Number | 1881476844
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Entity Type | Organization
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Legal Business Name | ADVANCED UROLOGY MEDICAL PRACTICE OF MONTGOMERY, PLLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 4216 CARMICHAEL RD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2804
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Country | US
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Telephone | 334-612-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 4216 CARMICHAEL RD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2804
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Country | US
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Telephone | 334-612-7890
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MICHAEL RITZUS
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Credential |
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Telephone | 334-549-2712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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