Basic Information
| Provider Information | |||||||||
| NPI: | 1679674048 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHOENIX UROLOGY OF ST. JOSEPH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 HEARTLAND RD | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645066200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162328877 | ||||||||
| FaxNumber: | 8162320307 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 HEARTLAND RD | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645066200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162328877 | ||||||||
| FaxNumber: | 8162320307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | PARTAMIAN | ||||||||
| AuthorizedOfficialFirstName: | KRIKOR | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8162328877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.