Provider Demographics
NPI:1770500399
Name:UROLOGY ASSOCIATES OF OHIO, INC.
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-228-0570
Mailing Address - Street 1:1220 E ELM ST
Mailing Address - Street 2:STE 101
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2850
Mailing Address - Country:US
Mailing Address - Phone:419-228-0570
Mailing Address - Fax:419-228-0943
Practice Address - Street 1:1220 E ELM ST
Practice Address - Street 2:STE 101
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2850
Practice Address - Country:US
Practice Address - Phone:419-228-0570
Practice Address - Fax:419-228-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448742Medicaid
OH9914133Medicare PIN
OH9914132Medicare PIN