1659367340 NPI number — THE UROLOGY TEAM PA

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 1659367340 NPI number — THE UROLOGY TEAM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE UROLOGY TEAM 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:
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:
1659367340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11410 JOLLYVILLE RD
Provider Second Line Business Mailing Address:
SUITE 1101
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-4097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-231-1444
Provider Business Mailing Address Fax Number:
512-231-1470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11410 JOLLYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 1101
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759-4097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-231-1456
Provider Business Practice Location Address Fax Number:
512-231-7059
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZELL
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
512-231-1456

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  174400000X , 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: CE8100 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0033BR . This is a "BLUE CROSS BLUE SHEILD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com