Provider Demographics
NPI:1649469487
Name:HIGHLAND LAKES UROLOGY PA
Entity type:Organization
Organization Name:HIGHLAND LAKES UROLOGY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAYTON
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-693-5889
Mailing Address - Street 1:2503 HWY 281 N
Mailing Address - Street 2:STE 400
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-693-5889
Mailing Address - Fax:830-693-5801
Practice Address - Street 1:2503 HWY 281 N
Practice Address - Street 2:STE 400
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-693-5889
Practice Address - Fax:830-693-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0308208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH14991Medicare UPIN
TX005676Medicare PIN