Provider Demographics
NPI:1689791899
Name:VALLEY UROLOGIC ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:VALLEY UROLOGIC ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:VLACH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:920-739-3537
Mailing Address - Street 1:820 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3483
Mailing Address - Country:US
Mailing Address - Phone:920-739-3537
Mailing Address - Fax:
Practice Address - Street 1:800 RIVERSIDE DR
Practice Address - Street 2:RIVERSIDE MEDICAL CENTER WAUPACA
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1943
Practice Address - Country:US
Practice Address - Phone:920-739-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32748300Medicaid
WI989963OtherUNITED HEALTHCARE
WI989963OtherUNITED HEALTHCARE