Provider Demographics
NPI:1003130873
Name:WASHINGTON UROLOGY PLLC
Entity Type:Organization
Organization Name:WASHINGTON UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUEGGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-378-9259
Mailing Address - Street 1:948 STEVENS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3547
Mailing Address - Country:US
Mailing Address - Phone:509-946-8000
Mailing Address - Fax:509-946-8002
Practice Address - Street 1:948 STEVENS DR
Practice Address - Street 2:SUITE C
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3547
Practice Address - Country:US
Practice Address - Phone:509-946-8000
Practice Address - Fax:509-946-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047050208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8463952Medicaid
WAH23531Medicare UPIN