Provider Demographics
NPI:1801389267
Name:ADVANCED UROLOGIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:ADVANCED UROLOGIC ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PAYOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-502-8782
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8782
Mailing Address - Fax:
Practice Address - Street 1:19001 E 48TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6964
Practice Address - Country:US
Practice Address - Phone:816-502-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKE'S HEALTH SYSTEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-11
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty