Provider Demographics
NPI:1568666287
Name:OCALA UROLOGY SPECIALISTS PA
Entity Type:Organization
Organization Name:OCALA UROLOGY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-732-6474
Mailing Address - Street 1:2850 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0440
Mailing Address - Country:US
Mailing Address - Phone:352-732-6474
Mailing Address - Fax:352-732-7205
Practice Address - Street 1:2850 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0440
Practice Address - Country:US
Practice Address - Phone:352-732-6474
Practice Address - Fax:352-732-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05611Medicare ID - Type Unspecified
G33640Medicare UPIN
FL1082390001Medicare NSC
32126Medicare ID - Type Unspecified
D51369Medicare UPIN