Provider Demographics
NPI:1023222338
Name:UROLOGICAL GROUP LTD
Entity Type:Organization
Organization Name:UROLOGICAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-779-4900
Mailing Address - Street 1:608 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6145
Mailing Address - Country:US
Mailing Address - Phone:309-277-3500
Mailing Address - Fax:309-277-3050
Practice Address - Street 1:608 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6145
Practice Address - Country:US
Practice Address - Phone:309-277-3500
Practice Address - Fax:309-277-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL628900Medicare ID - Type Unspecified
IAI2064Medicare ID - Type Unspecified