Healthcare Provider Details

I. General information

NPI: 1528279940
Provider Name (Legal Business Name): LIMA UROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ROUTE 224
GLANDORF OH
45848
US

IV. Provider business mailing address

770 WEST HIGH STREET SUITE 350
LIMA OH
45801-5901
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-8950
  • Fax: 419-224-7904
Mailing address:
  • Phone: 419-228-8950
  • Fax: 419-224-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUSSELL J TAYLOR
Title or Position: OWNER
Credential: MD
Phone: 419-228-8950