MEDICARE: CAPITOL UROLOGY, 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	174400000X	Specialist	5645	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437351079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITOL UROLOGY, INC.

Provider Business Mailing Address
First Line	:	1525 VISTA LN
Second Line	:	120
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4626
Country	:	US
Telephone Number	:	775-885-9991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 VISTA LN
Second Line	:	120
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4626
Country	:	US
Telephone Number	:	775-885-9991
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY DWIGHT UPTON
Credential	:	MD
Telephone Number	:	775-885-9991

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	02/26/2008

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Directions to “CAPITOL UROLOGY, INC. ” Practice Location

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