Provider Demographics
NPI:1104840701
Name:UROLOGY ASSOC OF RICHMOND. INC
Entity Type:Organization
Organization Name:UROLOGY ASSOC OF RICHMOND. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-320-1355
Mailing Address - Street 1:1401 JOHNSTON WILLIS DR
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:N CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-320-1355
Mailing Address - Fax:804-320-2786
Practice Address - Street 1:1401 JOHNSTON WILLIS DR
Practice Address - Street 2:SUITE 4500
Practice Address - City:N. CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-320-1355
Practice Address - Fax:804-320-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7517505Medicaid
VA7517505Medicaid
VAB06683Medicare UPIN
VA340000156Medicare ID - Type Unspecified
VA340000156Medicare Oscar/Certification