Provider Demographics
NPI:1043420599
Name:NORTH COLORADO UROLOGY PC
Entity Type:Organization
Organization Name:NORTH COLORADO UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WOLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-378-1000
Mailing Address - Street 1:5890 W 13TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4821
Mailing Address - Country:US
Mailing Address - Phone:970-378-1000
Mailing Address - Fax:970-378-1899
Practice Address - Street 1:5890 W 13TH ST
Practice Address - Street 2:STE 106
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4821
Practice Address - Country:US
Practice Address - Phone:970-378-1000
Practice Address - Fax:970-378-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52351564Medicaid
C97861Medicare PIN