Basic Information
| Provider Information | |||||||||
| NPI: | 1700131992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL REGION UROLOGICAL SURGEONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 319 S MANNING BLVD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122081742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184380507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19 WEST AVE | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128666049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185830111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2012 | ||||||||
| LastUpdateDate: | 07/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | YATES | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5184380507 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.