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General NPI Number Information
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NPI Number | 1477377026
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Entity Type | Organization
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Legal Business Name | UROLIFE CLINIC LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 256 SW PROFESSIONAL GLN
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City | LAKE CITY
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State | FL
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Zip | 32025-1104
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Country | US
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Telephone | 386-758-8937
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Fax |
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Provider Business Mailing Address
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Address Line | 256 SW PROFESSIONAL GLN
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City | LAKE CITY
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State | FL
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Zip | 32025-1104
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Country | US
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Telephone | 386-758-8937
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SARAH C DUMAS
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Credential |
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Telephone | 386-758-8937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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