MEDICARE: ADVANCED UROLOGY INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1053022681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED UROLOGY INSTITUTE LLC

Provider Business Mailing Address
First Line	:	2560 ENTERPRISE RD E
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-1010
Country	:	US
Telephone Number	:	727-796-5354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 ENTERPRISE RD E
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-1010
Country	:	US
Telephone Number	:	727-796-5354
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD WOOTEN
Credential	:
Telephone Number	:	919-397-8768

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/08/2022

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