Provider Demographics
NPI:1972549517
Name:PRESCOTT UROLOGY LTD
Entity Type:Organization
Organization Name:PRESCOTT UROLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-771-5282
Mailing Address - Street 1:811 AINSWORTH DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1687
Mailing Address - Country:US
Mailing Address - Phone:928-771-5282
Mailing Address - Fax:928-771-5283
Practice Address - Street 1:811 AINSWORTH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1687
Practice Address - Country:US
Practice Address - Phone:928-771-5282
Practice Address - Fax:928-771-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCHYPMedicare ID - Type Unspecified
AZ0774080001Medicare NSC