Provider Demographics
NPI:1881647246
Name:UROLOGY SPECIALISTS CHARTERED
Entity Type:Organization
Organization Name:UROLOGY SPECIALISTS CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CAO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN RN
Authorized Official - Phone:605-444-5409
Mailing Address - Street 1:201 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2403
Mailing Address - Country:US
Mailing Address - Phone:605-336-0635
Mailing Address - Fax:605-336-7182
Practice Address - Street 1:201 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2403
Practice Address - Country:US
Practice Address - Phone:605-336-0635
Practice Address - Fax:605-336-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0000019OtherBCBS OF SD
MN48345HAOtherBCBS OF MN
MN856710700Medicaid
SDCE2389OtherMEDICARE RAILROAD GROUP
SD04794UROtherBCBS OF MN
IA0700698Medicaid
IAI7717Medicare PIN
SDS19Medicare ID - Type UnspecifiedGROUP NUMBER
IA0700698Medicaid