1124472246 NPI number — APP UROLOGY CLINIC

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 1124472246 NPI number — APP UROLOGY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APP UROLOGY CLINIC
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:
1124472246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 748157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-8157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-789-5250
Provider Business Mailing Address Fax Number:
541-789-5538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
537 UNION AVE
Provider Second Line Business Practice Location Address:
SECOND FLOOR 2B
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97527-5543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-507-2020
Provider Business Practice Location Address Fax Number:
541-507-2021
Provider Enumeration Date:
04/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HOCKING
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CAFO
Authorized Official Telephone Number:
541-789-4916

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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