Provider Demographics
NPI:1891886867
Name:UROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES PC
Other - Org Name:GLACIER MEN'S HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDENORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-752-8456
Mailing Address - Street 1:350 HERITAGE WAY STE 2300
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3167
Mailing Address - Country:US
Mailing Address - Phone:406-752-8456
Mailing Address - Fax:406-752-1443
Practice Address - Street 1:350 HERITAGE WAY STE 2300
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3167
Practice Address - Country:US
Practice Address - Phone:406-752-8456
Practice Address - Fax:406-752-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000080612Medicare PIN