=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568529113
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROLOGY SPECIALISTS OF RICHMOND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7137 JAHNKE RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23225-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-232-0226
-----------------------------------------------------
Fax | 804-232-0229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7137 JAHNKE RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23225-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-232-0226
-----------------------------------------------------
Fax | 804-232-0229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | CAROL SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-237-7760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------