MEDICARE: THE UROLOGY CLINIC

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	:	1881754851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE UROLOGY CLINIC

Provider Business Mailing Address
First Line	:	602 N LEWIS ST STE 400
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2093
Country	:	US
Telephone Number	:	337-365-4113
Fax Number	:	337-365-4115

Provider Business Practice Location Address
First Line	:	602 N LEWIS ST STE 400
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2093
Country	:	US
Telephone Number	:	337-365-4113
Fax Number	:	337-365-4115

Authorized Official
Title or Position	:	INS CLERK
Name	:	KAT TUCKER
Credential	:
Telephone Number	:	337-365-4113

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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Directions to “THE UROLOGY CLINIC ” Practice Location

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