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General NPI Number Information
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NPI Number | 1558436782
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Entity Type | Organization
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Legal Business Name | NORTHWEST COLUMBUS UROLOGY, INC.
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 498 LONDON AVE SUITE H
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City | MARYSVILLE
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State | OH
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Zip | 43040-5512
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Country | US
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Telephone | 937-644-5240
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Fax | 937-644-3754
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Provider Business Mailing Address
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Address Line | 498 LONDON AVE SUITE H
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City | MARYSVILLE
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State | OH
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Zip | 43040-5512
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Country | US
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Telephone | 937-644-5240
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Fax | 937-644-3754
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY S KNUDSON
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Credential | M.D.
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Telephone | 937-644-5240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35055629
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35069365
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35069608
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35063160
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License Number State | OH
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