Provider Demographics
NPI:1720023062
Name:UROLOGIC HEALTH ASSOCIATES PLC
Entity Type:Organization
Organization Name:UROLOGIC HEALTH ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLOU
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-899-1696
Mailing Address - Street 1:PO BOX 2959
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:83299-2959
Mailing Address - Country:US
Mailing Address - Phone:480-899-1696
Mailing Address - Fax:480-963-6227
Practice Address - Street 1:1600 W CHANDLER BLVD
Practice Address - Street 2:STE 160
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6153
Practice Address - Country:US
Practice Address - Phone:480-899-1696
Practice Address - Fax:480-963-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ949555Medicaid
H96022Medicare UPIN
AZZ110465Medicare PIN