Provider Demographics
NPI:1881476844
Name:ADVANCED UROLOGY MEDICAL PRACTICE OF MONTGOMERY, PLLC
Entity type:Organization
Organization Name:ADVANCED UROLOGY MEDICAL PRACTICE OF MONTGOMERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RITZUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-549-2712
Mailing Address - Street 1:4216 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2804
Mailing Address - Country:US
Mailing Address - Phone:334-612-7890
Mailing Address - Fax:
Practice Address - Street 1:4216 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2804
Practice Address - Country:US
Practice Address - Phone:334-612-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED UROLOGY MEDICAL PRACTICE OF MONTGOMERY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-16
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site