Provider Demographics
NPI:1548451321
Name:ZANESVILLE UROLOGY INC
Entity type:Organization
Organization Name:ZANESVILLE UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:LANOUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-453-0548
Mailing Address - Street 1:751 FOREST AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2868
Mailing Address - Country:US
Mailing Address - Phone:740-453-0548
Mailing Address - Fax:740-453-2505
Practice Address - Street 1:751 FOREST AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2868
Practice Address - Country:US
Practice Address - Phone:740-453-0548
Practice Address - Fax:740-453-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2253841Medicaid
OH2253841Medicaid