1053493254 NPI number — WYOMING UROLOGICAL SERVICES, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053493254 NPI number — WYOMING UROLOGICAL SERVICES, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING UROLOGICAL SERVICES, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053493254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847324
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-7324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-314-4331
Provider Business Mailing Address Fax Number:
512-314-4494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 S CAPITAL OF TEXAS HWY
Provider Second Line Business Practice Location Address:
SUITE B200
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-314-4331
Provider Business Practice Location Address Fax Number:
512-314-4494
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CBO
Authorized Official Telephone Number:
512-314-4331

Provider Taxonomy Codes

  • Taxonomy code: 261QL0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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