1861410649 NPI number — CENTER FOR UROLOGIC HEALTH, LLC

Table of content: (NPI 1861410649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861410649 NPI number — CENTER FOR UROLOGIC HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR UROLOGIC HEALTH, LLC
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:
1861410649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 W EXCHANGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44302-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-376-8626
Provider Business Mailing Address Fax Number:
330-374-1180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 W EXCHANGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44302-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-376-8626
Provider Business Practice Location Address Fax Number:
330-374-1180
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DANESIS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
330-835-5584

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2638542 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".