Provider Demographics
NPI:1912198516
Name:TUSCARAWAS VALLEY UROLOGY, LTD
Entity Type:Organization
Organization Name:TUSCARAWAS VALLEY UROLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:GIGAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-364-2311
Mailing Address - Street 1:300 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2073
Mailing Address - Country:US
Mailing Address - Phone:330-364-2311
Mailing Address - Fax:330-364-7802
Practice Address - Street 1:300 MEDICAL PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2073
Practice Address - Country:US
Practice Address - Phone:330-364-2311
Practice Address - Fax:330-364-7802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUSCARAWAS VALLEY UROLOGY, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080679G174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2489310Medicaid
OHI07174Medicare UPIN
9344591Medicare PIN