1215960034 NPI number — UROLOGY SPECIALTY GROUP LLC

Table of content: (NPI 1215960034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215960034 NPI number — UROLOGY SPECIALTY GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY SPECIALTY GROUP 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:
1215960034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 SW 62ND AVE
Provider Second Line Business Mailing Address:
STE. 340
Provider Business Mailing Address City Name:
SOUTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33143-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-661-9692
Provider Business Mailing Address Fax Number:
305-667-0630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 SW 62ND AVE
Provider Second Line Business Practice Location Address:
STE. 340
Provider Business Practice Location Address City Name:
SOUTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33143-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-661-9692
Provider Business Practice Location Address Fax Number:
305-667-0630
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BONDHUS
Authorized Official First Name:
MARVIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-661-9692

Provider Taxonomy Codes

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

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

  • Identifier: 271579100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579109 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579112 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579108 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD3820 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271579101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579103 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5636224 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271579102 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579113 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579118 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74984 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271579105 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579110 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579111 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579114 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579117 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579116 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271579104 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE4135 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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