Provider Demographics
NPI:1407898877
Name:UROLOGY CENTER OF NORTHEASTERN KY
Entity Type:Organization
Organization Name:UROLOGY CENTER OF NORTHEASTERN KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:C
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-324-4404
Mailing Address - Street 1:PO BOX 2619
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2619
Mailing Address - Country:US
Mailing Address - Phone:606-324-4404
Mailing Address - Fax:606-325-6822
Practice Address - Street 1:336 29TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1900
Practice Address - Country:US
Practice Address - Phone:606-324-4404
Practice Address - Fax:606-325-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
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
9726Medicare ID - Type Unspecified