Provider Demographics
NPI:1508042185
Name:URO-MEDIX INC
Entity Type:Organization
Organization Name:URO-MEDIX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-748-4771
Mailing Address - Street 1:8890 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7235
Mailing Address - Country:US
Mailing Address - Phone:954-748-4771
Mailing Address - Fax:
Practice Address - Street 1:6100 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7900
Practice Address - Country:US
Practice Address - Phone:954-987-3010
Practice Address - Fax:954-987-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21199AMedicare PIN