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General NPI Number Information
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NPI Number | 1063439826
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Entity Type | Organization
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Legal Business Name | UROLOGY SPECIALTY CARE, PSC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 1851 N. MAIN ST.
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City | MADISONVILLE
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State | KY
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Zip | 42431
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Country | US
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Telephone | 270-821-7739
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Fax | 270-821-0278
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Provider Business Mailing Address
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Address Line | 1851 N. MAIN ST.
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City | MADISONVILLE
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State | KY
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Zip | 42431
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Country | US
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Telephone | 270-821-7739
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Fax | 270-821-0278
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Authorized Official
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Title or Position | OWNER
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Name | ANNA M D'AMICO
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Credential | MD
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Telephone | 270-821-7739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35189
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License Number State | KY
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