Provider Demographics
NPI:1144460064
Name:GOLDEN TRIANGLE UROLOGY PLLC
Entity type:Organization
Organization Name:GOLDEN TRIANGLE UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-327-2921
Mailing Address - Street 1:321 HOSPITAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1920
Mailing Address - Country:US
Mailing Address - Phone:662-327-2921
Mailing Address - Fax:662-328-6858
Practice Address - Street 1:321 HOSPITAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1920
Practice Address - Country:US
Practice Address - Phone:662-327-2921
Practice Address - Fax:662-328-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12474208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01726810Medicaid
AL109115Medicaid
DP0484OtherRAILROAD MEDICARE
AL730-19417OtherBLUE CROSS BLUE SHIELD
DP0484OtherRAILROAD MEDICARE