Provider Demographics
NPI:1629159587
Name:UROLOGICAL SURGERY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:UROLOGICAL SURGERY ASSOCIATES PLLC
Other - Org Name:UROLOGY ASSOCIATES OF MS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-936-4645
Mailing Address - Street 1:294 E LAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9526
Mailing Address - Country:US
Mailing Address - Phone:601-936-4645
Mailing Address - Fax:
Practice Address - Street 1:294 E LAYFAIR DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9526
Practice Address - Country:US
Practice Address - Phone:601-936-4645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9014795Medicaid
MS9014795Medicaid