Provider Demographics
NPI:1629074562
Name:UROLOGY CENTER PARTNERSHIP
Entity Type:Organization
Organization Name:UROLOGY CENTER PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-835-3271
Mailing Address - Street 1:5652 MEADOWLANE ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4005
Mailing Address - Country:US
Mailing Address - Phone:727-842-9561
Mailing Address - Fax:727-848-7270
Practice Address - Street 1:5652 MEADOWLANE ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4005
Practice Address - Country:US
Practice Address - Phone:727-842-9561
Practice Address - Fax:727-848-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 62352208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15167ZMedicare ID - Type Unspecified
F30305Medicare UPIN