=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053517862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE UROLOGY CLINIC LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10503 W THUNDERBIRD BLVD SUITE 317
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-974-3621
-----------------------------------------------------
Fax | 480-596-6860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6114 N NAUNI VALLEY DR
-----------------------------------------------------
City | PARADISE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85253-5162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-974-3621
-----------------------------------------------------
Fax | 480-596-6860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARRY L STERN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 623-974-3621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 05046
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------