MEDICARE: UROLOGY ASSOCIATES OF NORTH TEXAS LLP

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

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	:	1790778256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY ASSOCIATES OF NORTH TEXAS LLP

Provider Business Mailing Address
First Line	:	PO BOX 120549
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-0549
Country	:	US
Telephone Number	:	817-303-4521
Fax Number	:	817-459-2856

Provider Business Practice Location Address
First Line	:	811 W INTERSTATE 20
Second Line	:	SUITE 114
City	:	ARLINGTON
State	:	TX
Zip	:	76017
Country	:	US
Telephone Number	:	817-784-0818
Fax Number	:	817-276-1861

Authorized Official
Title or Position	:	CENTRAL BUSINESS OFFICE MANAGER
Name	:	THERESA D WILSON
Credential	:
Telephone Number	:	817-303-4521

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	12/07/2011

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