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General NPI Number Information
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NPI Number | 1174703623
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL UROLOGY PA
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 4218 GATEWAY DRIVE SUITE 100
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City | COLLEYVILLE
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State | TX
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Zip | 76034
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Country | US
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Telephone | 817-283-1860
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Fax | 817-283-2175
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Provider Business Mailing Address
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Address Line | 4218 GATEWAY DRIVE SUITE 100
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City | COLLEYVILLE
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State | TX
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Zip | 76034
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Country | US
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Telephone | 817-283-1860
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Fax | 817-283-2175
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | J NOVITSKI
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Credential | B.S.B.A.
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Telephone | 817-283-1860
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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 | H0705
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License Number State | TX
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