Organization
COOSA VALLEY UROLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAMOUN R PACHA M.D. (OWNER)
(256) 245-2269
Entity
Organization
Contact information
Practice address
16 SOUTH DOUGLAS AVENUE, SYLACAUGA, AL 35150
(256) 245-2269
(256) 245-2260
Mailing address
16 SOUTH DOUGLAS AVENUE, SYLACAUGA, AL 35150
(256) 245-2269
(256) 245-2260
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8767
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1910002
UNITED HEALTH CARE
AL
01
—
340007817
RAILROAD MEDICARE
AL
05
—
529603840
—
AL
Enumeration date
04/20/2007
Last updated
10/04/2013
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