Provider Demographics
NPI:1639285943
Name:MEDICAL CENTER UROLOGY PA
Entity Type:Organization
Organization Name:MEDICAL CENTER UROLOGY PA
Other - Org Name:MEDICAL CENTER UROLOGY PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PUSCHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-882-0220
Mailing Address - Street 1:624 QUAKER LN
Mailing Address - Street 2:STE C103
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262
Mailing Address - Country:US
Mailing Address - Phone:336-882-0220
Mailing Address - Fax:336-882-1207
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:STE C103
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-882-0220
Practice Address - Fax:336-882-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0212WOtherBCBS
NC890214KMedicaid
NC0212WOtherBCBS
G05074Medicare UPIN