Provider Demographics
NPI:1780718809
Name:UROLOGY TYLER, PA
Entity type:Organization
Organization Name:UROLOGY TYLER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:PYBURN
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-262-3900
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:#700
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-262-3900
Mailing Address - Fax:
Practice Address - Street 1:7909 FREDERICKSBURG RD
Practice Address - Street 2:#150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3425
Practice Address - Country:US
Practice Address - Phone:210-521-7700
Practice Address - Fax:210-521-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory