Provider Demographics
NPI:1427013440
Name:UROLOGICAL ASSOCIATES OF SAVANNAH, PC
Entity Type:Organization
Organization Name:UROLOGICAL ASSOCIATES OF SAVANNAH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-790-4000
Mailing Address - Street 1:PO BOX 14459
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1459
Mailing Address - Country:US
Mailing Address - Phone:912-790-4000
Mailing Address - Fax:912-790-4407
Practice Address - Street 1:230 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6736
Practice Address - Country:US
Practice Address - Phone:912-790-4000
Practice Address - Fax:912-790-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACG5245OtherRAILROAD MEDICARE
SCGPA715Medicaid
GA1291820001Medicare NSC
GAGRP3583Medicare ID - Type Unspecified