Provider Demographics
NPI:1437282308
Name:ADULT & PEDIATRIC UROLOGY PC
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EUCLID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DESOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-7989
Mailing Address - Street 1:PO BOX 8577
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-0577
Mailing Address - Country:US
Mailing Address - Phone:402-397-7989
Mailing Address - Fax:402-397-8703
Practice Address - Street 1:3434 W BROADWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3291
Practice Address - Country:US
Practice Address - Phone:402-397-7989
Practice Address - Fax:712-328-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
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
IA0424739Medicaid
NE098396Medicare ID - Type UnspecifiedGROUP NEBR MEDICARE NUMBE
IA70090Medicare ID - Type UnspecifiedGROUP IOWA MEDICARE NUMBE