Provider Demographics
NPI:1053488395
Name:UROLOGY CENTER, PC
Entity Type:Organization
Organization Name:UROLOGY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-397-9800
Mailing Address - Street 1:111 S 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3907
Mailing Address - Country:US
Mailing Address - Phone:402-397-9800
Mailing Address - Fax:402-397-7591
Practice Address - Street 1:2301 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566
Practice Address - Country:US
Practice Address - Phone:712-623-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42613Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER