Provider Demographics
NPI:1467649251
Name:STILLWATER UROLOGY INC.
Entity Type:Organization
Organization Name:STILLWATER UROLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-377-3858
Mailing Address - Street 1:816 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4349
Mailing Address - Country:US
Mailing Address - Phone:405-377-3858
Mailing Address - Fax:
Practice Address - Street 1:816 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4349
Practice Address - Country:US
Practice Address - Phone:405-377-3858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC95158Medicare UPIN