Healthcare Provider Details

I. General information

NPI: 1770500399
Provider Name (Legal Business Name): UROLOGY ASSOCIATES OF OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E ELM ST STE 101
LIMA OH
45804-2850
US

IV. Provider business mailing address

1220 E ELM ST STE 101
LIMA OH
45804-2850
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-0570
  • Fax: 419-228-0943
Mailing address:
  • Phone: 419-228-0570
  • Fax: 419-228-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0448742
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: KENNETH E STANLEY
Title or Position: TREASURER
Credential: MD
Phone: 419-228-0570