1619274164 NPI number — ADVANCED UROLOGY HEALTH CENTER INC

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 1619274164 NPI number — ADVANCED UROLOGY HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED UROLOGY HEALTH CENTER 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:
1619274164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27087 GRATIOT AVE
Provider Second Line Business Mailing Address:
2ND FL
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48066-2985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-498-9440
Provider Business Mailing Address Fax Number:
586-498-9460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 MAJOR SHERMAN LANE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-4643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-373-3600
Provider Business Practice Location Address Fax Number:
831-373-0690
Provider Enumeration Date:
02/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
POSCH
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR, QUALITY OPERATIONS
Authorized Official Telephone Number:
586-498-9440

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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