1881785764 NPI number — UROLOGY ASSOCIATES OF THE CENTRAL COAST

Table of content: (NPI 1881785764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881785764 NPI number — UROLOGY ASSOCIATES OF THE CENTRAL COAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY ASSOCIATES OF THE CENTRAL COAST
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:
1881785764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 PRADO RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-786-2500
Provider Business Mailing Address Fax Number:
805-781-0423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 PRADO RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-7363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-786-2500
Provider Business Practice Location Address Fax Number:
805-781-0423
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANFIELD
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-541-1111

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)

  • Identifier: GR0041431 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0041430 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0041432 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0041433 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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