Healthcare Provider Details

I. General information

NPI: 1962274977
Provider Name (Legal Business Name): BTX PREMIER UROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W JEFFERSON ST STE 170
BROWNSVILLE TX
78520-6300
US

IV. Provider business mailing address

PO BOX 4948
BROWNSVILLE TX
78523-4948
US

V. Phone/Fax

Practice location:
  • Phone: 956-255-5010
  • Fax: 956-255-5011
Mailing address:
  • Phone: 956-255-5010
  • 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: KENNETH A EWANE
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 956-255-5010