Provider Demographics
NPI:1780631564
Name:STATE COLLEGE UROLOGIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:STATE COLLEGE UROLOGIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-272-3148
Mailing Address - Street 1:905 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6626
Mailing Address - Country:US
Mailing Address - Phone:814-238-8418
Mailing Address - Fax:814-234-2888
Practice Address - Street 1:905 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6626
Practice Address - Country:US
Practice Address - Phone:814-238-8418
Practice Address - Fax:814-234-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006452570001Medicaid
PA0006452570001Medicaid
PAF31189Medicare UPIN
PAF51520Medicare UPIN