1194720730 NPI number — UROLOGY ASSOCIATES OF CENTRAL CALIFORNIA, INC

Table of content: (NPI 1194720730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194720730 NPI number — UROLOGY ASSOCIATES OF CENTRAL CALIFORNIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY ASSOCIATES OF CENTRAL CALIFORNIA, 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:
UROLOGY ASSOCIATES OF CENTRAL CALIFORNIA AMBULATORY SURGICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1194720730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7014 N WHITNEY AVE
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-0155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-321-2898
Provider Business Mailing Address Fax Number:
559-321-2026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7014 N WHITNEY AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-0155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-321-2898
Provider Business Practice Location Address Fax Number:
559-321-2026
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DALE
Authorized Official First Name:
GILBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
559-321-2898

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  040000484 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SUR01435F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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