Provider Demographics
NPI:1881704773
Name:THE UROLOGY INSTITUTE AMBULATORY SURGERY CENTER
Entity type:Organization
Organization Name:THE UROLOGY INSTITUTE AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-227-0086
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799
Mailing Address - Country:US
Mailing Address - Phone:229-227-0086
Mailing Address - Fax:229-227-5929
Practice Address - Street 1:817 SMITH AVENUE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-227-0086
Practice Address - Fax:229-227-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00935569AMedicaid
GA111198ASCAMedicare ID - Type Unspecified