MEDICARE: UROSYNERGY,INC

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	363LF0000X	Family Nurse Practitioner	ARNP3090472	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538501978	OTHER	FL	NPI

General Provider Information

NPI Number	:	1407271141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROSYNERGY,INC

Provider Business Mailing Address
First Line	:	5489 WILES RD
Second Line	:	SUITE 302
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4220
Country	:	US
Telephone Number	:	954-210-5563
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 SW 3RD ST
Second Line	:	SUITE 100
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6934
Country	:	US
Telephone Number	:	954-210-5563
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	DR. CAROL CHRISTINE JOHNSON MCGREGOR
Credential	:	FNP-BC
Telephone Number	:	954-210-5563

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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Directions to “UROSYNERGY,INC ” Practice Location

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