Provider Demographics
NPI:1043297542
Name:UROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-250-9260
Mailing Address - Street 1:PO BOX 409879
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9879
Mailing Address - Country:US
Mailing Address - Phone:615-261-6000
Mailing Address - Fax:615-250-6052
Practice Address - Street 1:2801 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4035
Practice Address - Country:US
Practice Address - Phone:615-250-9200
Practice Address - Fax:615-250-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710218Medicaid
KY65912180Medicaid
KY227466OtherANTHEM BCBS OF KENTUCKY
TN2006687OtherBCBS OF TN
TN2006687OtherBCBS OF TN
KY6089Medicare PIN
KY227466OtherANTHEM BCBS OF KENTUCKY