Provider Demographics
NPI:1740208628
Name:UNIVERSITY UROLOGY PC
Entity Type:Organization
Organization Name:UNIVERSITY UROLOGY PC
Other - Org Name:UNIVERSITY UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-305-9254
Mailing Address - Street 1:1928 ALCOA HWY STE 222
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1504
Mailing Address - Country:US
Mailing Address - Phone:865-305-9254
Mailing Address - Fax:865-305-9716
Practice Address - Street 1:1928 ALCOA HWY
Practice Address - Street 2:BLDG B SUITE 222
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-305-9254
Practice Address - Fax:865-305-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty