Provider Demographics
NPI:1235289356
Name:CENTER UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:CENTER UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-725-4400
Mailing Address - Street 1:PO BOX 352408
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-2408
Mailing Address - Country:US
Mailing Address - Phone:419-725-4400
Mailing Address - Fax:419-535-7463
Practice Address - Street 1:4646 NANTUCKETT DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3194
Practice Address - Country:US
Practice Address - Phone:419-725-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0594129Medicaid
OH4032363OtherAETNA
OH306582913012OtherMEDICAL MUTUAL OF OH
OH000000133106OtherANTHEM
OH00548OtherPARAMOUNT
OH00548OtherPARAMOUNT
OH=========012OtherUHC
OHSE0571943Medicare ID - Type Unspecified