Provider Demographics
NPI:1063676054
Name:UROMED, INC.
Entity Type:Organization
Organization Name:UROMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-841-1233
Mailing Address - Street 1:3975 JOHNS CREEK CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1298
Mailing Address - Country:US
Mailing Address - Phone:800-841-1233
Mailing Address - Fax:678-417-0139
Practice Address - Street 1:5205 AVENIDA ENCINAS
Practice Address - Street 2:SUITE E
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4366
Practice Address - Country:US
Practice Address - Phone:800-841-1233
Practice Address - Fax:678-417-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47554332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
12461OtherINLAND EMPIRE HEALTH PLAN
CA8609639Medicaid
=========OtherINLAND EMPIRE HEALTH PLAN
12461OtherINLAND EMPIRE HEALTH PLAN
CA8609639Medicaid