Provider Demographics
NPI:1770535197
Name:UROLOGY SPECIALISTS PC
Entity type:Organization
Organization Name:UROLOGY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-221-6845
Mailing Address - Street 1:2700 CLAY EDWARDS DR
Mailing Address - Street 2:STE 300
Mailing Address - City:NKC
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3249
Mailing Address - Country:US
Mailing Address - Phone:816-842-0171
Mailing Address - Fax:816-842-3582
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:STE 300
Practice Address - City:NKC
Practice Address - State:MO
Practice Address - Zip Code:64116-3249
Practice Address - Country:US
Practice Address - Phone:816-842-0171
Practice Address - Fax:816-842-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR4926174400000X
MOR2E53174400000X
MO105398174400000X
MO31894174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID
MO4498338AMedicare ID - Type Unspecified
MO4493294AMedicare ID - Type Unspecified
MOG69145Medicare UPIN
MO=========OtherTAX ID
MOC50331Medicare UPIN
MO4493764AMedicare ID - Type UnspecifiedMEDICARE
MOC51686Medicare UPIN
MOC51454Medicare UPIN