Provider Demographics
NPI:1164133799
Name:ADVANCED UROLOGY INSTITUTE LLC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-397-8768
Mailing Address - Street 1:2148 DUCK SLOUGH BLVD STE 102-103
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5068
Mailing Address - Country:US
Mailing Address - Phone:727-375-1975
Mailing Address - Fax:
Practice Address - Street 1:2148 DUCK SLOUGH BLVD STE 102-103
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5068
Practice Address - Country:US
Practice Address - Phone:727-375-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED UROLOGY INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-05
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies