Provider Demographics
NPI:1780764688
Name:BRISTOL UROLOGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BRISTOL UROLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:T
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-844-6600
Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-844-6600
Mailing Address - Fax:423-968-1255
Practice Address - Street 1:350 BLOUNTVILLE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0213
Practice Address - Country:US
Practice Address - Phone:423-844-6600
Practice Address - Fax:423-968-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2007375OtherBLUECROSS BLUESHIELD
709078OtherBLUE CROSS BLUE SHIELD PA
064741OtherANTHEM
TN0213340004OtherUMWA
TN2007375OtherBLUECROSS BLUESHIELD
709078OtherBLUE CROSS BLUE SHIELD PA