1114905163 NPI number — UROMED, INC

Table of content: (NPI 1114905163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114905163 NPI number — UROMED, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROMED, INC
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:
1114905163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3975 JOHNS CREEK CT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-1298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-841-1233
Provider Business Mailing Address Fax Number:
678-417-0139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3975 JOHNS CREEK CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-1298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-841-1233
Provider Business Practice Location Address Fax Number:
678-417-0139
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINKLE
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SR. VP OPERATIONS
Authorized Official Telephone Number:
800-841-1233

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010352501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100798870A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689386 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000702314A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003104156 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01674928 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155532716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0266797 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10023042 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11969 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7330502 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 951804500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011908301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 035398100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME950 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015877930005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90112301 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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