Provider Demographics
NPI:1255435343
Name:UROLOGIC SURGICAL ASSOCIATES OF DELAWARE
Entity type:Organization
Organization Name:UROLOGIC SURGICAL ASSOCIATES OF DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GROUP ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:SCHANNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-571-8958
Mailing Address - Street 1:1815 W 13TH ST
Mailing Address - Street 2:THE STATION SUITE 4
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4054
Mailing Address - Country:US
Mailing Address - Phone:302-517-8958
Mailing Address - Fax:302-571-1320
Practice Address - Street 1:1815 W 13TH ST
Practice Address - Street 2:THE STATION SUITE 4
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4054
Practice Address - Country:US
Practice Address - Phone:302-517-8958
Practice Address - Fax:302-571-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2003100929208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000030182OtherDELAWARE PHYSICIANS
2278204000OtherAMERIHEALTH PERS CHOICE
DA9575OtherRAILROAD MEDICARE
2278204000OtherKEYSTONE
2278204000OtherAMERIHEALTH HMO
1000030182OtherDIAMOND STATE PARTNERS
1000030182OtherEDS
08D1018688OtherRAILROAD MEDICARE
1000030182OtherEDS
G01124Medicare ID - Type Unspecified
1000030182OtherEDS