Provider Demographics
NPI:1922052505
Name:UROLOGIC SURGERY ASSOCIATES, PA
Entity Type:Organization
Organization Name:UROLOGIC SURGERY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-438-3833
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:STE 105
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2306
Mailing Address - Country:US
Mailing Address - Phone:913-438-3833
Mailing Address - Fax:913-438-3832
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:STE 105
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-438-3833
Practice Address - Fax:913-438-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
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
KSF510000Medicare ID - Type Unspecified
MOF510000AMedicare ID - Type Unspecified