Provider Demographics
NPI:1346410032
Name:UNIVERSITY UROLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:UNIVERSITY UROLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:COUTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-276-2001
Mailing Address - Street 1:195 COLLYER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1869
Mailing Address - Country:US
Mailing Address - Phone:401-272-7799
Mailing Address - Fax:401-276-9299
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:SUITE 523
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-272-7799
Practice Address - Fax:401-272-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty