MTN LAKE UROLOGY PC (NPI# 1801050364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801050364 |
| Entity Type | Organization |
| Organization Name | MTN LAKE UROLOGY PC |
| Practice Address |
750 Byron Rd Scottsboro AL 35769-4051 |
| Practice Telephone | 2562598765 |
| Practice Fax Number | 2567168060 |
| Mailing Telephone | 2562598765 |
| Mailing Fax Number | 2567168060 |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2018-03-21 |
| Authorized Official Name | SHERRY GROSS (OFFICE MANAGER) |
| Authorized Official Telephone | 2562598765 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 17993 | AL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 106277 | 05 |
| Street Address |
750 BYRON RD |
| City | SCOTTSBORO |
| State | AL |
| Zip Code | 35769-4051 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225023344 | Michael Grayson Simmons | Urology | 750 Byron Rd, Scottsboro, AL 35769-4051 | 2005-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831718535 | Healthpointe | Internal Medicine | 24020 John T Reid Pkwy, Scottsboro, AL 35769 | 2020-04-13 |
| 1780192765 | Family First Medicine LLC | Family Medicine | 1601 Veterans Drive, Scottsboro, AL 35769 | 2018-01-12 |
| 1023566205 | Allyscripts LLC | Pharmacy | 201 Lonnie E Crawford Blvd, Suite B, Scottsboro, AL 35769 | 2016-09-15 |
| 1386971257 | Jonathan Wallace Gurr | Pediatrics | 23800 John T. Reid Pkwy, Scottsboro, AL 35769 | 2009-11-12 |
| 1174645923 | The Arc of Jackson County | Day Training, Developmentally Disabled Services | 180 Mack Morris Drive, Scottsboro, AL 35769 | 2007-04-04 |
| 1588742233 | State of Alabama Department of Public Health | Home Health | 294 Liberty Lane, Scottsboro, AL 35769 | 2006-11-01 |
| 1851463368 | State of Alabama Department of Public Health | Home Health | 294 Liberty Lane, Scottsboro, AL 35769 | 2006-11-14 |
| 1598319121 | Stacy Kennamer | Occupational Therapist | 157 Brad St, Scottsboro, AL 35769-3419 | 2019-07-31 |
| 1376864132 | Laurel Rico | Occupational Therapist | 692 Ruby Johnson Dr, Scottsboro, AL 35769-3633 | 2010-06-16 |
| 1497848063 | Douglass Vance | Military Health Care Provider | 264 Belle Dr, Scottsboro, AL 35769-3652 | 2006-10-02 |
| Find all providers in zip 35769 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821027137 | Durwood M. Hodges Jr. | Specialist | 307 Parks Ave, Scottsboro, AL 35768-2411 | 2006-06-30 |
| 1740452176 | Sarah L Boxley | Specialist | 508 Gregory St, Scottsboro, AL 35768-4239 | 2008-03-26 |
| 1497935399 | Alabama Urology Northeast | Specialist | 504 Harley St, Scottsboro, AL 35768-4219 | 2007-11-07 |
| 1932319605 | Tuesday Bigelow Cosmetic Surgery Center | Specialist | 1202 S Broad St, Scottsboro, AL 35768-2516 | 2007-05-23 |
| 1780787598 | Alicia Johnson Fossett | Specialist | 508 Gregory St, Scottsboro, AL 35768-4239 | 2006-09-07 |
| 1255443214 | Edythe Bolden | Specialist | 508 Gregory St, Scottsboro, AL 35768-4239 | 2006-08-31 |
| 1770542573 | Sleep Medicine PC | Specialist | 380 Woods Cove Rd, Scottsboro, AL 35768-2428 | 2006-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235745571 | Rachel Kestler | Specialist | 4102 Gadiator Street, Fort Rucker, AL 36362 | 2020-09-22 |
| 1528699444 | Jackson Hospital and Clinic, Inc | Specialist | 321 Greenville Byp Ste 2, Greenville, AL 36037-3757 | 2020-01-29 |
| 1548809403 | Mizell Memorial Hospital, Inc. | Specialist | 103 E Memorial Ave Ste A, Opp, AL 36467-1746 | 2019-12-24 |
| 1013564285 | Octavia Elisa Bruce | Specialist | 808 Green Springs Hwy, Suite 124 Studio 4, Homewood, AL 35216 | 2019-08-22 |
| 1407417702 | Sasha J White | Specialist | 410 Governors Dr. Sw, Huntsville, AL 35801 | 2019-06-26 |
| 1609342088 | Vituro Health of Georgia, LLC | Specialist | 2901 2nd Ave S Ste 130, Birmingham, AL 35233-2928 | 2018-10-23 |
| 1598248205 | Almatriga Vladzetta Essex | Specialist | 1110 15th St Ste G, Tuscaloosa, AL 35401-3393 | 2018-09-09 |
| 1013428580 | Larry Dell Turner | Specialist | 600 S Court St Ste 312, Montgomery, AL 36104-4106 | 2017-10-23 |
| 1447789870 | Alexis Lindsey | Specialist | 1909 Commerce Avenue Nw, Cullman, AL 35055 | 2017-06-08 |
| 1912447210 | Neal Laye | Specialist | 29 W 3rd St, Suite B, Sylacauga, AL 35150-2480 | 2017-03-06 |
| Find all providers with the same taxonomy | ||||
| City | SCOTTSBORO |
| Zip Code | 35769 |
Please comment or provide details below to improve the information on MTN LAKE UROLOGY PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.