Provider Demographics
NPI:1598082364
Name:ALLIED UROLOGY INC
Entity Type:Organization
Organization Name:ALLIED UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:OGBOLU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-710-4510
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-0537
Mailing Address - Country:US
Mailing Address - Phone:937-710-4510
Mailing Address - Fax:937-710-4776
Practice Address - Street 1:1025 FAIR RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8947
Practice Address - Country:US
Practice Address - Phone:937-710-4510
Practice Address - Fax:937-710-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009725208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2244771Medicaid
OH2244771Medicaid