Provider Demographics
NPI:1770751034
Name:ADVANCE UROLOGY & CONTINENCE CENTER LLC
Entity type:Organization
Organization Name:ADVANCE UROLOGY & CONTINENCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-335-2500
Mailing Address - Street 1:725 S SHOOP AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1702
Mailing Address - Country:US
Mailing Address - Phone:419-335-2500
Mailing Address - Fax:419-335-7500
Practice Address - Street 1:725 S SHOOP AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1702
Practice Address - Country:US
Practice Address - Phone:419-335-2500
Practice Address - Fax:419-335-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091037261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9374791Medicare PIN