Provider Demographics
NPI:1417252594
Name:MID-STATE UROLOGY PC
Entity Type:Organization
Organization Name:MID-STATE UROLOGY PC
Other - Org Name:MID-SOUTH PEDIATRIC UROLOGY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:BRAREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-321-0481
Mailing Address - Street 1:329 21ST AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1839
Mailing Address - Country:US
Mailing Address - Phone:615-321-0481
Mailing Address - Fax:615-321-5649
Practice Address - Street 1:329 21ST AVE N
Practice Address - Street 2:SUITE 2
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1839
Practice Address - Country:US
Practice Address - Phone:615-321-0481
Practice Address - Fax:615-321-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty