Provider Demographics
NPI:1790778256
Name:UROLOGY ASSOCIATES OF NORTH TEXAS LLP
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF NORTH TEXAS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTRAL BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-303-4521
Mailing Address - Street 1:PO BOX 120549
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-0549
Mailing Address - Country:US
Mailing Address - Phone:817-303-4521
Mailing Address - Fax:817-459-2856
Practice Address - Street 1:811 W INTERSTATE 20
Practice Address - Street 2:SUITE 114
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:817-784-0818
Practice Address - Fax:817-276-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109535803Medicaid
TX109535803Medicaid