MEDICARE: THE UROLOGY GROUP, PLLC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1457384489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE UROLOGY GROUP, PLLC

Provider Business Mailing Address
First Line	:	1211 N SHARTEL AVE STE 300
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-235-8008
Fax Number	:	405-235-0902

Provider Business Practice Location Address
First Line	:	1211 N SHARTEL AVE STE 300
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-235-8008
Fax Number	:	405-235-0902

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BARBARA G HAGUE
Credential	:
Telephone Number	:	405-235-8008

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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