Basic Information
| Provider Information | |||||||||
| NPI: | 1891878013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED UROGYNECOLOGY & PELVIC SURGERY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7759 UNIVERSITY DRIVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5513463430 | ||||||||
| FaxNumber: | 5134634310 | ||||||||
| Practice Location | |||||||||
| Address1: | 7759 UNIVERSITY DRIVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134634300 | ||||||||
| FaxNumber: | 5134634310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 06/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | KELLER | ||||||||
| AuthorizedOfficialFirstName: | CONSTANCE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING & FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5134634315 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BS, MBA | ||||||||
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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.