Healthcare Provider Details

I. General information

NPI: 1063644631
Provider Name (Legal Business Name): UROLOGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE SUITE 800
FT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

1625 SE 3RD AVE SUITE 800
FT LAUDERDALE FL
33316-2521
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-5135
  • Fax:
Mailing address:
  • Phone: 954-355-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA SCROGGINS
Title or Position: CONSULTANT
Credential:
Phone: 561-630-6277