Provider Demographics
NPI:1306037296
Name:SUBURBAN UROLOGY NETWORK PLLC
Entity Type:Organization
Organization Name:SUBURBAN UROLOGY NETWORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FINKELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:307-734-1525
Mailing Address - Street 1:PO BOX 13099
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-3099
Mailing Address - Country:US
Mailing Address - Phone:307-734-1525
Mailing Address - Fax:307-733-8276
Practice Address - Street 1:557 E BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-734-1525
Practice Address - Fax:307-733-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYF71233Medicare UPIN
WYW10327Medicare PIN
WYW10327Medicare Oscar/Certification