East Alabama Urology Associates, P.A.

Contacts

Phone	+1 334-749-8146
Fax	3347376432

Authorized person

Name	BONNIE KELLER
Role	ADMINISTRATOR
Phone	3347498146

Taxonomy

Taxonomy Code	208800000X - Urology Physician
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	529700320
State	AL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1972-09-30
Business code	621111
Sponsor’s telephone number	3347498146
Plan sponsor’s address	121 N 20TH STREET, SUITE 19, OPELIKA, AL, 36801