Provider Demographics
NPI:1699847509
Name:YOUNG & YOUNG UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:YOUNG & YOUNG UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:CARR
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, FNP
Authorized Official - Phone:979-779-6615
Mailing Address - Street 1:PO BOX 3607
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-3607
Mailing Address - Country:US
Mailing Address - Phone:979-779-6615
Mailing Address - Fax:979-823-2785
Practice Address - Street 1:1404 BRISTOL
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-779-6615
Practice Address - Fax:979-823-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083310501Medicaid
TX00JH31OtherBLUE CROSS GROUP NUMBER
TXCP4127OtherMEDICARE RAILROAD
TX083310501Medicaid