Basic Information
| Provider Information | |||||||||
| NPI: | 1356364335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 PINE LAKE RD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685163389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024898888 | ||||||||
| FaxNumber: | 4024211945 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 PINE LAKE RD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024898888 | ||||||||
| FaxNumber: | 4024211945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | CRUSINBERRY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4024898888 | ||||||||
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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 | N | Suppliers | Durable Medical Equipment & Medical Supplies | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | CO4248 | 01 | NE | RR MEDICARE | OTHER |