1952511339 NPI number — MEMORIAL UROLOGY ASSOCIATES, PA

Table of content: (NPI 1952511339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952511339 NPI number — MEMORIAL UROLOGY ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL UROLOGY ASSOCIATES, 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:
1952511339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 GESSNER RD
Provider Second Line Business Mailing Address:
SUITE 720
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77024-2527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-830-9200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7907 FREDRICKSBURG
Provider Second Line Business Practice Location Address:
SUITE 150 RM J
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-830-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SELZMAN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
713-830-9200

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 084518202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00603909 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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