Provider Demographics
NPI:1144225624
Name:UROLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:UROLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:WYCHE
Authorized Official - Last Name:BICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-545-9713
Mailing Address - Street 1:4100 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1076
Mailing Address - Country:US
Mailing Address - Phone:719-545-9713
Mailing Address - Fax:719-545-2054
Practice Address - Street 1:4100 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1076
Practice Address - Country:US
Practice Address - Phone:719-545-9713
Practice Address - Fax:719-545-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORU608163OtherBLUE CROSS BLUE SHIELD
CO77878272Medicaid
CORU608163OtherBLUE CROSS BLUE SHIELD