Provider Demographics
NPI:1710965173
Name:URO-MEDIX, INC.
Entity Type:Organization
Organization Name:URO-MEDIX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANTOSEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-748-4771
Mailing Address - Street 1:8890 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7235
Mailing Address - Country:US
Mailing Address - Phone:954-748-4771
Mailing Address - Fax:954-748-6755
Practice Address - Street 1:8890 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7235
Practice Address - Country:US
Practice Address - Phone:954-748-4771
Practice Address - Fax:954-748-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21199Medicare PIN