Provider Demographics
NPI:1679674048
Name:PHOENIX UROLOGY OF ST. JOSEPH, INC.
Entity Type:Organization
Organization Name:PHOENIX UROLOGY OF ST. JOSEPH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIKOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:PARTAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-232-8877
Mailing Address - Street 1:901 HEARTLAND RD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6200
Mailing Address - Country:US
Mailing Address - Phone:816-232-8877
Mailing Address - Fax:816-232-0307
Practice Address - Street 1:901 HEARTLAND RD
Practice Address - Street 2:SUITE 1800
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6200
Practice Address - Country:US
Practice Address - Phone:816-232-8877
Practice Address - Fax:816-232-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF27637Medicare UPIN
MOE03687Medicare UPIN
MOC51740Medicare UPIN