Provider Demographics
NPI:1346320652
Name:CLINICAL UROLOGY, INC
Entity Type:Organization
Organization Name:CLINICAL UROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-634-7727
Mailing Address - Street 1:4200 S. DOUGLAS AVE.
Mailing Address - Street 2:STE. 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109
Mailing Address - Country:US
Mailing Address - Phone:405-634-7727
Mailing Address - Fax:405-634-7844
Practice Address - Street 1:4200 S. DOUGLAS AVE.
Practice Address - Street 2:STE. 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109
Practice Address - Country:US
Practice Address - Phone:405-634-7727
Practice Address - Fax:405-634-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OK11232174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051540AMedicaid
D35071Medicare UPIN