Provider Demographics
NPI:1588682892
Name:CANTON UROLOGY ASSOCIATION,INC
Entity Type:Organization
Organization Name:CANTON UROLOGY ASSOCIATION,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:KMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-458-2000
Mailing Address - Street 1:2600 W TUSCARAWAS
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-458-2000
Mailing Address - Fax:330-458-2010
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 400
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4698
Practice Address - Country:US
Practice Address - Phone:330-458-2000
Practice Address - Fax:330-458-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223350Medicaid
OH0223350Medicaid