Provider Demographics
NPI:1376675918
Name:CARSON UROLOGISTS LTD
Entity Type:Organization
Organization Name:CARSON UROLOGISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-883-1030
Mailing Address - Street 1:412 W JOHN ST # 1B
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-8811
Mailing Address - Country:US
Mailing Address - Phone:775-883-1030
Mailing Address - Fax:775-883-4677
Practice Address - Street 1:925 IRONWOOD DR STE 2103
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-5180
Practice Address - Country:US
Practice Address - Phone:775-883-1030
Practice Address - Fax:775-883-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC9684OtherANTHEM BCBS NEVADA
NVCR1134OtherRR MEDICARE
NVCR1134OtherRR MEDICARE
NVVWJBJDMedicare ID - Type UnspecifiedEDI MEDICARE