Provider Demographics
NPI:1902839038
Name:THAMES UROLOGY CENTER, LLC
Entity Type:Organization
Organization Name:THAMES UROLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-443-0622
Mailing Address - Street 1:3 SHAW'S COVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320
Mailing Address - Country:US
Mailing Address - Phone:860-443-0622
Mailing Address - Fax:860-443-5531
Practice Address - Street 1:3 SHAW'S COVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-443-0622
Practice Address - Fax:860-443-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02905OtherFIRST COAST SERV. OPTIONS MEDICARE PART B GOUP ID