1437257235 NPI number — UROLOGIC SURGERY ASSOCIATES, P.A

Table of content: JAMIE LEE KEENE ARNP (NPI 1184888661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437257235 NPI number — UROLOGIC SURGERY ASSOCIATES, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGIC SURGERY ASSOCIATES, P.A
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:
1437257235
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:
3824 OAKWATER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-6263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-826-8999
Provider Business Mailing Address Fax Number:
407-826-8995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3824 OAKWATER CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-6263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-826-8999
Provider Business Practice Location Address Fax Number:
407-826-8995
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
407-826-8999

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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