Provider Demographics
NPI:1659367340
Name:THE UROLOGY TEAM PA
Entity Type:Organization
Organization Name:THE UROLOGY TEAM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ZELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:512-231-1456
Mailing Address - Street 1:11410 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4097
Mailing Address - Country:US
Mailing Address - Phone:512-231-1444
Mailing Address - Fax:512-231-1470
Practice Address - Street 1:11410 JOLLYVILLE RD
Practice Address - Street 2:SUITE 1101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4097
Practice Address - Country:US
Practice Address - Phone:512-231-1456
Practice Address - Fax:512-231-7059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UROLOGY TEAM PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-27
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCE8100OtherRAIL ROAD MEDICARE
TX0033BROtherBLUE CROSS BLUE SHEILD TX
TXCE8100OtherRAIL ROAD MEDICARE