Basic Information
| Provider Information | |||||||||
| NPI: | 1669946398 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | 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: | 4023979800 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 S 90TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979800 | ||||||||
| FaxNumber: | 4023977591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2019 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | FOREHEAD | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4023979800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UROLOGY CENTER, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.