Provider Demographics
NPI:1477512937
Name:MID-PENN UROLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:MID-PENN UROLOGIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SWINEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:570-372-9933
Mailing Address - Street 1:5 ATRIUM CT
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9017
Mailing Address - Country:US
Mailing Address - Phone:570-372-9933
Mailing Address - Fax:570-372-0828
Practice Address - Street 1:5 ATRIUM CT
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9017
Practice Address - Country:US
Practice Address - Phone:570-372-9933
Practice Address - Fax:570-372-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
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
PA16723Medicare ID - Type Unspecified