Provider Demographics
NPI:1912117698
Name:GREENVILLE UROLOGY GROUP LLC
Entity Type:Organization
Organization Name:GREENVILLE UROLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:662-334-9829
Mailing Address - Street 1:344 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4711
Mailing Address - Country:US
Mailing Address - Phone:662-334-8564
Mailing Address - Fax:662-334-8539
Practice Address - Street 1:344 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4711
Practice Address - Country:US
Practice Address - Phone:662-334-8564
Practice Address - Fax:662-334-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18690208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDD4966OtherRAILROAD MEDICARE
MS01926301Medicaid
MSC03273Medicare ID - Type Unspecified