Provider Demographics
NPI:1104392232
Name:UROLOGIC INTEGRATED CARE LLC
Entity Type:Organization
Organization Name:UROLOGIC INTEGRATED CARE LLC
Other - Org Name:UROLOGIC INTEGRATED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-278-5132
Mailing Address - Street 1:5745 SW 75TH ST # 507
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5504
Mailing Address - Country:US
Mailing Address - Phone:352-204-5400
Mailing Address - Fax:352-204-5405
Practice Address - Street 1:1201 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4220
Practice Address - Country:US
Practice Address - Phone:352-204-5400
Practice Address - Fax:352-204-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010592700Medicaid