Provider Demographics
NPI:1932226107
Name:ADVANCED UROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY ASSOCIATES, LLC
Other - Org Name:ACCENT UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:STILL III
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-966-4992
Mailing Address - Street 1:PO BOX 952853
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-0001
Mailing Address - Country:US
Mailing Address - Phone:314-966-4992
Mailing Address - Fax:314-966-4511
Practice Address - Street 1:2355 DOUGHERTY FERRY RD
Practice Address - Street 2:SUITE 410
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3325
Practice Address - Country:US
Practice Address - Phone:314-966-4992
Practice Address - Fax:314-966-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9826208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG3173OtherMEDICARE RAILROAD
MO502184401Medicaid
MODG3173OtherMEDICARE RAILROAD
MO5097620001Medicare NSC