Healthcare Provider Details

I. General information

NPI: 1003092685
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

2825 N STATE ROAD 7 SUITE 203
MARGATE FL
33063-5737
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 954-748-4771
  • Fax: 954-748-6755
Mailing address:
  • Phone: 954-748-4771
  • Fax: 954-748-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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