Provider Demographics
NPI:1982659991
Name:AFFILIATED UROLOGY SPECIALISTS, LTD.
Entity Type:Organization
Organization Name:AFFILIATED UROLOGY SPECIALISTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HASTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-655-7704
Mailing Address - Street 1:200 E PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3089
Mailing Address - Country:US
Mailing Address - Phone:309-655-7700
Mailing Address - Fax:309-655-7720
Practice Address - Street 1:200 E PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3089
Practice Address - Country:US
Practice Address - Phone:309-655-7700
Practice Address - Fax:309-655-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL979013Medicare PIN
ILC39989Medicare UPIN
ILE18419Medicare UPIN
IL979010Medicare PIN
ILI10427Medicare UPIN
ILR78360Medicare UPIN
CM0096Medicare PIN