Provider Demographics
NPI:1528070182
Name:TOMBALL UROLOGY ASSOCIATES,PA
Entity type:Organization
Organization Name:TOMBALL UROLOGY ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-290-9800
Mailing Address - Street 1:919 GRAHAM DR
Mailing Address - Street 2:STE. A
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6408
Mailing Address - Country:US
Mailing Address - Phone:281-290-9800
Mailing Address - Fax:281-290-9824
Practice Address - Street 1:919 GRAHAM DR
Practice Address - Street 2:STE. A
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6408
Practice Address - Country:US
Practice Address - Phone:281-290-9800
Practice Address - Fax:281-290-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER