MEDICARE: PREMIER UROLOGY 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	:	1669339925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER UROLOGY PLLC

Provider Business Mailing Address
First Line	:	215 KINGWOOD EXECUTIVE DR STE 250
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2765
Country	:	US
Telephone Number	:	281-358-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 KINGWOOD EXECUTIVE DR STE 250
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2765
Country	:	US
Telephone Number	:	281-358-0171
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MILLER CALLAWAY
Credential	:
Telephone Number	:	251-786-1446

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/20/2026

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