MEDICARE: UROLOGY CLINICS OF NORTH TEXAS, 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	207RH0003X	Hematology & Oncology Physician
2	2088P0231X	Pediatric Urology Physician	G9345	TX
3	2085R0001X	Radiation Oncology Physician	K3232	TX
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
5	208800000X	Urology Physician	M0918	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CI6342	OTHER	TX	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0036DE	OTHER		BCBS GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720031370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY CLINICS OF NORTH TEXAS, PLLC

Provider Business Mailing Address
First Line	:	1650 REPUBLIC PKWY STE 130
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-6920
Country	:	US
Telephone Number	:	214-692-8262
Fax Number	:	214-696-4190

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN
Second Line	:	SUITE 700
City	:	DALLAS
State	:	TX
Zip	:	75231-4482
Country	:	US
Telephone Number	:	214-691-1902
Fax Number	:	214-987-1845

Authorized Official
Title or Position	:	CEO
Name	:	JERRI D WILSON
Credential	:
Telephone Number	:	214-691-1902

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/18/2025

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