Provider Demographics
NPI:1154301166
Name:PEDIATRIC UROLOGY ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:PEDIATRIC UROLOGY ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-279-1697
Mailing Address - Street 1:1920 E CAMBRIDGE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1459
Mailing Address - Country:US
Mailing Address - Phone:602-279-1697
Mailing Address - Fax:602-264-0461
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-279-1697
Practice Address - Fax:602-264-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103741Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER