MEDICARE: NORTHWOODS UROLOGY ASSOCIATION

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

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	:	1437383908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS UROLOGY ASSOCIATION

Provider Business Mailing Address
First Line	:	P.O.BOX 4959
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77201
Country	:	US
Telephone Number	:	281-404-3000
Fax Number	:	936-273-5628

Provider Business Practice Location Address
First Line	:	1140 CYPRESS STATION DR # A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3045
Country	:	US
Telephone Number	:	281-580-4000
Fax Number	:	281-580-9999

Authorized Official
Title or Position	:	M.D.
Name	:	DR. PAUL KENWORTHY
Credential	:	M.D.
Telephone Number	:	281-404-3000

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	07/18/2011

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