Provider Demographics
NPI:1265461370
Name:SOUTHWEST UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-948-3101
Mailing Address - Street 1:PO BOX 678164
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8164
Mailing Address - Country:US
Mailing Address - Phone:214-948-3101
Mailing Address - Fax:214-941-7633
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:SUITE 464
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-948-3101
Practice Address - Fax:214-941-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196814101Medicaid
TX00Y766Medicare PIN