Basic Information
| Provider Information | |||||||||
| NPI: | 1114919875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE UROLOGY CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 S 90TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979800 | ||||||||
| FaxNumber: | 4023977591 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 90TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979800 | ||||||||
| FaxNumber: | 4023977591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FOREHEAD | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4023979800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.