Provider Demographics
NPI:1376667428
Name:URO-MEDIX, INC
Entity Type:Organization
Organization Name:URO-MEDIX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-456-6500
Mailing Address - Street 1:2500 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:PH 2
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4834
Mailing Address - Country:US
Mailing Address - Phone:954-456-6500
Mailing Address - Fax:954-456-6503
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD
Practice Address - Street 2:PH 2
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4834
Practice Address - Country:US
Practice Address - Phone:954-456-6500
Practice Address - Fax:954-456-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48050208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty