Provider Demographics
NPI:1639517626
Name:NORTHSHORE UROLOGY LLC
Entity Type:Organization
Organization Name:NORTHSHORE UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MCQUAY
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:865-406-1264
Mailing Address - Street 1:9625 KROGER PARK DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5880
Mailing Address - Country:US
Mailing Address - Phone:865-406-1264
Mailing Address - Fax:865-539-0909
Practice Address - Street 1:9625 KROGER PARK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5880
Practice Address - Country:US
Practice Address - Phone:865-406-1264
Practice Address - Fax:865-539-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS91981Medicare UPIN