Provider Demographics
NPI:1811038235
Name:SOUTH PITTSBURGH UROLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH PITTSBURGH UROLOGIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-469-1002
Mailing Address - Street 1:1200 BROOKS LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-1002
Mailing Address - Fax:412-469-8925
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE 220
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-469-1002
Practice Address - Fax:412-469-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA436752Medicare ID - Type Unspecified