Provider Demographics
NPI:1093090334
Name:NATHAN W. UY, MD, PA
Entity Type:Organization
Organization Name:NATHAN W. UY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-252-1684
Mailing Address - Street 1:1400 W 4TH ST
Mailing Address - Street 2:PO BOX 993
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3306
Mailing Address - Country:US
Mailing Address - Phone:620-252-1684
Mailing Address - Fax:620-252-1692
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3306
Practice Address - Country:US
Practice Address - Phone:620-252-1684
Practice Address - Fax:620-252-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-310732085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK14737148954OtherINDIVIDUAL NPI
OK20004400AMedicaid
KSAPPLIED FORMedicaid
OK14737148954OtherINDIVIDUAL NPI