Basic Information
| Provider Information | |||||||||
| NPI: | 1255439477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIAMI COUNTY UROLOGISTS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 632421 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452632421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003575728 | ||||||||
| FaxNumber: | 9372912962 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 N. DIXIE HWY. | ||||||||
| Address2: | STE. 205 | ||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373350061 | ||||||||
| FaxNumber: | 9373399336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUSSAIN | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMAD | ||||||||
| AuthorizedOfficialMiddleName: | BELAYET | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9373350061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0406200001 | 01 | OH | DME | OTHER |