Provider Demographics
NPI:1295831675
Name:CASCADES UROLOGY CENTER, INC.
Entity Type:Organization
Organization Name:CASCADES UROLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-423-8090
Mailing Address - Street 1:1651 N LAKE CT
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1351
Mailing Address - Country:US
Mailing Address - Phone:419-423-8090
Mailing Address - Fax:419-423-8902
Practice Address - Street 1:1651 N LAKE CT
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1351
Practice Address - Country:US
Practice Address - Phone:419-423-8090
Practice Address - Fax:419-423-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5397820001Medicare NSC
OHY29925Medicare UPIN
OHCA9351671Medicare ID - Type Unspecified