Provider Demographics
NPI:1720316318
Name:INSTITUTE OF UROLOGY, LLC
Entity Type:Organization
Organization Name:INSTITUTE OF UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNALDO
Authorized Official - Middle Name:FRANCESCO
Authorized Official - Last Name:TRABUCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-768-6800
Mailing Address - Street 1:PO BOX 33660
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89028-3660
Mailing Address - Country:US
Mailing Address - Phone:928-768-6800
Mailing Address - Fax:
Practice Address - Street 1:5300 S HIGHWAY 95
Practice Address - Street 2:SUITE K
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:928-768-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42374208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ513717Medicaid
AZ513717Medicaid
AZZ136111Medicare PIN