Provider Demographics
NPI:1134319981
Name:SOUTHWEST UROLOGIC SPECIALISTS, PC
Entity Type:Organization
Organization Name:SOUTHWEST UROLOGIC SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:WORISCHECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:480-892-3059
Mailing Address - Street 1:6007 E BASELINE RD
Mailing Address - Street 2:#105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4801
Mailing Address - Country:US
Mailing Address - Phone:480-892-3059
Mailing Address - Fax:
Practice Address - Street 1:6007 E. BASELINE ROAD
Practice Address - Street 2:#105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5044
Practice Address - Country:US
Practice Address - Phone:480-892-3059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1099953OtherUNITED HEALTH CARE
AZ0172120OtherBLUE CROSS BLUE SHIELD
AZ108664Medicaid
AZ1099953OtherUNITED HEALTH CARE