Provider Demographics
NPI:1285844670
Name:UROLOGY SPECIALISTS OF NORTHWEST OHIO, LLC
Entity Type:Organization
Organization Name:UROLOGY SPECIALISTS OF NORTHWEST OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:HOPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-517-1022
Mailing Address - Street 1:7640 SYLVANIA AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9729
Mailing Address - Country:US
Mailing Address - Phone:419-517-1022
Mailing Address - Fax:419-517-1026
Practice Address - Street 1:7640 W SYLVANIA AVE STE L
Practice Address - Street 2:SUITE L
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9263
Practice Address - Country:US
Practice Address - Phone:419-517-1022
Practice Address - Fax:419-517-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082931208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2419172Medicaid
OH2419172Medicaid
OH9356471Medicare ID - Type Unspecified