Provider Demographics
NPI:1336286251
Name:FLORIDA UROLOGY CENTER PA
Entity Type:Organization
Organization Name:FLORIDA UROLOGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-673-5100
Mailing Address - Street 1:300 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5956
Mailing Address - Country:US
Mailing Address - Phone:386-673-5100
Mailing Address - Fax:386-673-6014
Practice Address - Street 1:300 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5956
Practice Address - Country:US
Practice Address - Phone:386-673-5100
Practice Address - Fax:386-673-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC77286Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER