Provider Demographics
NPI:1336117225
Name:AFFILIATED UROLOGISTS OF GREATER AUSTIN
Entity Type:Organization
Organization Name:AFFILIATED UROLOGISTS OF GREATER AUSTIN
Other - Org Name:ADULT & PEDIATRIC UROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-416-0444
Mailing Address - Street 1:4207 JAMES CASEY ST
Mailing Address - Street 2:STE 107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3300
Mailing Address - Country:US
Mailing Address - Phone:512-416-0444
Mailing Address - Fax:512-442-2533
Practice Address - Street 1:4207 JAMES CASEY ST
Practice Address - Street 2:STE 107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3300
Practice Address - Country:US
Practice Address - Phone:512-416-0444
Practice Address - Fax:512-442-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N46AOtherBLUE CROSS NUMBER
TX00N46AOtherBLUE CROSS NUMBER
TX00N46AMedicare PIN