Provider Demographics
NPI:1649478751
Name:PLAZA UROLOGY GROUP, P.C.
Entity type:Organization
Organization Name:PLAZA UROLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-756-7860
Mailing Address - Street 1:1300 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2005
Practice Address - Country:US
Practice Address - Phone:423-756-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00575341AMedicaid
GA640896503AMedicaid
GA895428138AMedicaid
P00031711OtherRAIL ROAD MEDICARE
GA00235628AMedicaid
340003880OtherRAIL ROAD MEDICARE
340007732OtherRAIL ROAD MEDICARE
340013888OtherRAIL ROAD MEDICARE
P00255345OtherRAIL ROAD MEDICARE
GA003714181AMedicaid
GA00235628AMedicaid
GA103992Medicare PIN
340003880OtherRAIL ROAD MEDICARE
TNB58935Medicare UPIN
TNH82420Medicare UPIN
TNI32732Medicare UPIN
GA640896503AMedicaid