Healthcare Provider Details

I. General information

NPI: 1629074562
Provider Name (Legal Business Name): UROLOGY CENTER PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5652 MEADOWLANE ST
NEW PORT RICHEY FL
34652-4005
US

IV. Provider business mailing address

5652 MEADOWLANE ST
NEW PORT RICHEY FL
34652-4005
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-9561
  • Fax: 727-848-7270
Mailing address:
  • Phone: 727-842-9561
  • Fax: 727-848-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME 62352
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID W JORDAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-835-3271