Provider Demographics
NPI:1437383908
Name:NORTHWOODS UROLOGY ASSOCIATION
Entity Type:Organization
Organization Name:NORTHWOODS UROLOGY ASSOCIATION
Other - Org Name:NORTHWOODS UROLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-404-3000
Mailing Address - Street 1:P.O.BOX 4959
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77201
Mailing Address - Country:US
Mailing Address - Phone:281-404-3000
Mailing Address - Fax:936-273-5628
Practice Address - Street 1:1140 CYPRESS STATION DR # A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3045
Practice Address - Country:US
Practice Address - Phone:281-580-4000
Practice Address - Fax:281-580-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083481402Medicaid
TX0975580001Medicare NSC
TX0A3684Medicare PIN
TX083481402Medicaid