=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811565187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROLOGY ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2021
-----------------------------------------------------
Last Update Date | 12/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7720 S BROADWAY STE 500
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-733-8848
-----------------------------------------------------
Fax | 303-733-3107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 913363
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80291-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-733-8848
-----------------------------------------------------
Fax | 303-733-0106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | REBECCA ISRAEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-733-8848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------