Provider Demographics
NPI:1689455305
Name:UROLOGIC REFERENCE LAB LLC
Entity Type:Organization
Organization Name:UROLOGIC REFERENCE LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,RHIT
Authorized Official - Phone:662-432-0700
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0829
Mailing Address - Country:US
Mailing Address - Phone:662-432-0700
Mailing Address - Fax:662-842-0566
Practice Address - Street 1:499 GLOSTER CREEK VLG STE A1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4749
Practice Address - Country:US
Practice Address - Phone:662-432-0700
Practice Address - Fax:662-842-0566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY PROFESSIONAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty