Provider Demographics
NPI:1982886842
Name:UROLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-867-0325
Mailing Address - Street 1:1303 N MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-9746
Mailing Address - Country:US
Mailing Address - Phone:435-867-0325
Mailing Address - Fax:
Practice Address - Street 1:1303 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9746
Practice Address - Country:US
Practice Address - Phone:435-867-0325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-03
Last Update Date:2018-11-05
Deactivation Date:2017-11-09
Deactivation Code:
Reactivation Date:2018-11-05
Provider Licenses
StateLicense IDTaxonomies
UT165247-1205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055752Medicare PIN