Provider Demographics
NPI:1164485876
Name:VIRGINIA UROLOGY CENTER
Entity Type:Organization
Organization Name:VIRGINIA UROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-287-6100
Mailing Address - Street 1:9101 STONY POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2002
Mailing Address - Country:US
Mailing Address - Phone:804-330-9105
Mailing Address - Fax:804-287-6119
Practice Address - Street 1:9101 STONY POINT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-2002
Practice Address - Country:US
Practice Address - Phone:804-330-9105
Practice Address - Fax:804-287-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208800000X
208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACA4541Medicare PIN
VACA4542Medicare PIN
VAC04008Medicare PIN
VAC06623Medicare PIN
VACN6547Medicare PIN
VAC06052Medicare PIN
VAC00882Medicare PIN
VAC01241Medicare PIN
VAC04057Medicare PIN
VAC06633Medicare PIN
VAC05484Medicare PIN
VACA6752Medicare PIN
VACC6581Medicare PIN
VACL9160Medicare PIN
CA9160Medicare UPIN
VAC04385Medicare PIN