MEDICARE: ADVANCED UROLOGY ASSOCIATES, LLC

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	R9826	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG3173	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932226107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED UROLOGY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 952853
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-0001
Country	:	US
Telephone Number	:	314-966-4992
Fax Number	:	314-966-4511

Provider Business Practice Location Address
First Line	:	2355 DOUGHERTY FERRY RD
Second Line	:	SUITE 410
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-966-4992
Fax Number	:	314-966-4511

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD H STILL III
Credential	:	D.O.
Telephone Number	:	314-966-4992

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	11/11/2009

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Directions to “ADVANCED UROLOGY ASSOCIATES, LLC ” Practice Location

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