Provider Demographics
NPI:1912916131
Name:RENAISSANCE UROLOGY CENTERS PA
Entity Type:Organization
Organization Name:RENAISSANCE UROLOGY CENTERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SEIBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-683-7342
Mailing Address - Street 1:PO BOX 720657
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0657
Mailing Address - Country:US
Mailing Address - Phone:956-683-7342
Mailing Address - Fax:956-683-0957
Practice Address - Street 1:2717 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8464
Practice Address - Country:US
Practice Address - Phone:956-683-7342
Practice Address - Fax:953-683-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164633301Medicaid
TX0046KYOtherBC/BS
TXDB0026OtherRAILROAD MEDICARE
TXDB0026OtherRAILROAD MEDICARE