Provider Demographics
NPI:1972532190
Name:BROWNWOOD UROLOGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:BROWNWOOD UROLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CRESCENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-643-2000
Mailing Address - Street 1:100 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5947
Mailing Address - Country:US
Mailing Address - Phone:325-643-2000
Mailing Address - Fax:
Practice Address - Street 1:100 MILLER DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5947
Practice Address - Country:US
Practice Address - Phone:325-643-2000
Practice Address - Fax:325-643-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0093NTOtherBLUE CROSS
TX182555601Medicaid
TX0093NTOtherBLUE CROSS
TX182555601Medicaid