Provider Demographics
NPI:1235234931
Name:OUTPATIENT UROLOGY CENTER OF DOVER, LLC
Entity Type:Organization
Organization Name:OUTPATIENT UROLOGY CENTER OF DOVER, LLC
Other - Org Name:OUTPATIENT UROLOGY CENTER OF DOVER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANSISCO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:302-736-8808
Mailing Address - Street 1:740 S NEW ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3571
Mailing Address - Country:US
Mailing Address - Phone:302-736-8808
Mailing Address - Fax:302-736-5996
Practice Address - Street 1:740 S NEW ST
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3571
Practice Address - Country:US
Practice Address - Phone:302-736-8808
Practice Address - Fax:302-736-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFSSC-011261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038889Medicaid
DEA00047Medicare PIN