Provider Demographics
NPI:1669416442
Name:TENNESSEE UROLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:TENNESSEE UROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:000-000-0000
Mailing Address - Street 1:10200 GRAND CENTRAL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 OAK RIDGE TPKE STE A101
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6958
Practice Address - Country:US
Practice Address - Phone:865-483-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714759Medicaid
TNCI2260OtherMEDICARE RAILROAD
TN3714755Medicaid
TNCI2260OtherMEDICARE RAILROAD
TN3714753Medicare ID - Type Unspecified
TN3714759Medicare ID - Type Unspecified
TN3714755Medicare ID - Type Unspecified
TN3714750Medicare ID - Type Unspecified
TN3714755Medicaid
TN3714755Medicaid