Provider Demographics
NPI:1396836359
Name:NORTHWOODS UROLOGY ASSOCIATION
Entity Type:Organization
Organization Name:NORTHWOODS UROLOGY ASSOCIATION
Other - Org Name:NORTHWOODS UROLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-404-3000
Mailing Address - Street 1:PO BOX 4959
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210
Mailing Address - Country:US
Mailing Address - Phone:281-404-3000
Mailing Address - Fax:936-273-5628
Practice Address - Street 1:135 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3001
Practice Address - Country:US
Practice Address - Phone:281-404-3000
Practice Address - Fax:936-273-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083481402Medicaid
TX083481402Medicaid
TX0975580001Medicare NSC
TX00K41DMedicare PIN