Provider Demographics
NPI:1780491134
Name:SPRINGFIELD UROLOGY LLC
Entity type:Organization
Organization Name:SPRINGFIELD UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNAMRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-342-9260
Mailing Address - Street 1:2365 LAKEVIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2365 LAKEVIEW DR STE C
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3639
Practice Address - Country:US
Practice Address - Phone:937-342-9260
Practice Address - Fax:937-342-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site