Provider Demographics
NPI:1407271141
Name:UROSYNERGY,INC
Entity Type:Organization
Organization Name:UROSYNERGY,INC
Other - Org Name:THE BLADDER CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:JOHNSON MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:954-210-5563
Mailing Address - Street 1:5489 WILES RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4220
Mailing Address - Country:US
Mailing Address - Phone:954-210-5563
Mailing Address - Fax:
Practice Address - Street 1:550 SW 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6934
Practice Address - Country:US
Practice Address - Phone:954-210-5563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3090472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1538501978OtherNPI