Provider Demographics
NPI:1073649877
Name:UROGYN SERVICES, LLC
Entity Type:Organization
Organization Name:UROGYN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-576-2224
Mailing Address - Street 1:3401 COSGROVE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4886
Mailing Address - Country:US
Mailing Address - Phone:608-576-2224
Mailing Address - Fax:
Practice Address - Street 1:1130 COLLINS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2939
Practice Address - Country:US
Practice Address - Phone:920-674-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2490-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43961200Medicaid
WI000114050Medicare PIN
Q29840Medicare UPIN
WI43961200Medicaid