Provider Demographics
NPI:1588685499
Name:CAPITOL UROLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CAPITOL UROLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FEUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-733-6238
Mailing Address - Street 1:3939 J ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:916-733-6233
Mailing Address - Fax:916-733-6230
Practice Address - Street 1:6600 MERCY CT
Practice Address - Street 2:SUITE 150
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-961-9696
Practice Address - Fax:916-536-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G59055261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F15088Medicare UPIN