Healthcare Provider Details

I. General information

NPI: 1508042185
Provider Name (Legal Business Name): URO-MEDIX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HOLLYWOOD BLVD SUITE 100
HOLLYWOOD FL
33024-7900
US

IV. Provider business mailing address

8890 W OAKLAND PARK BLVD SUITE 304
SUNRISE FL
33351-7235
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-3010
  • Fax: 954-987-0032
Mailing address:
  • Phone: 954-748-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TONI KELLY
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-748-4771