Provider Demographics
NPI:1003836040
Name:TEXOMA UROLOGY CENTER
Entity Type:Organization
Organization Name:TEXOMA UROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOWD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-689-8765
Mailing Address - Street 1:5500 KELL WEST BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1612
Mailing Address - Country:US
Mailing Address - Phone:940-689-8765
Mailing Address - Fax:940-689-8769
Practice Address - Street 1:5500 KELL WEST BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1612
Practice Address - Country:US
Practice Address - Phone:940-689-8765
Practice Address - Fax:940-689-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6172208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCS6543OtherRAILROAD MEDICARE
TX00E527OtherBLUE CROSS & BLUE SHIELD
TX0243510001OtherMEDICARE DME, PALMETTO
TX00E527Medicare PIN