Provider Demographics
NPI:1497948491
Name:SAN ANTONIO UROLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SAN ANTONIO UROLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:U
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-949-8866
Mailing Address - Street 1:1175 E ARROW HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5525
Mailing Address - Country:US
Mailing Address - Phone:909-985-9737
Mailing Address - Fax:909-981-1203
Practice Address - Street 1:1175 E ARROW HWY
Practice Address - Street 2:SUITE E
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5525
Practice Address - Country:US
Practice Address - Phone:909-985-9737
Practice Address - Fax:909-981-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47013Medicare UPIN