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General NPI Number Information
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NPI Number | 1487988671
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Entity Type | Organization
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Legal Business Name | UROLOGY ASSOCIATES FACILITY
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 675 BALLY ROW
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City | MANSFIELD
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State | OH
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Zip | 44906-2967
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Country | US
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Telephone | 419-756-4999
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Fax | 419-756-4949
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Provider Business Mailing Address
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Address Line | 675 BALLY ROW
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City | MANSFIELD
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State | OH
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Zip | 44906-2967
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Country | US
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Telephone | 419-756-4999
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Fax | 419-756-4949
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STJEPAN GARDILCIC
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Credential | M.D.
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Telephone | 419-756-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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