Provider Demographics
NPI:1215009121
Name:BELIS UROLOGIC INC
Entity Type:Organization
Organization Name:BELIS UROLOGIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-946-1259
Mailing Address - Street 1:2500 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3812
Mailing Address - Country:US
Mailing Address - Phone:814-946-1259
Mailing Address - Fax:
Practice Address - Street 1:2500 5TH STREET
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3812
Practice Address - Country:US
Practice Address - Phone:814-946-1259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMDO2657OE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009267120004Medicaid
PA0009267120004Medicaid