Provider Demographics
NPI:1669403440
Name:UROLOGY ASSOCIATES OF NORTH CENTRAL OHIO, INC.
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES OF NORTH CENTRAL OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STJEPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDILCIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-756-4999
Mailing Address - Street 1:675 BALLY ROW
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-756-4999
Mailing Address - Fax:419-756-4949
Practice Address - Street 1:675 BALLY ROW
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-756-4999
Practice Address - Fax:419-756-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7897208OtherAETNA
OHCH5270OtherRAILROAD MEDICARE
OH7897208OtherAETNA
OH9313271Medicare PIN