1558608026 NPI number — UROLOGY WITH DIGNITY PA

Table of content: (NPI 1558608026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558608026 NPI number — UROLOGY WITH DIGNITY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY WITH DIGNITY PA
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:
6
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:
1558608026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4499 MEDICAL DR
Provider Second Line Business Mailing Address:
SUITE151
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-593-4392
Provider Business Mailing Address Fax Number:
210-593-0152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4499 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 151
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-593-4392
Provider Business Practice Location Address Fax Number:
210-593-0152
Provider Enumeration Date:
01/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
210-593-4392

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  H4546 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 126427705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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