Provider Demographics
NPI:1730205113
Name:NORTH UROLOGY, LTD.
Entity type:Organization
Organization Name:NORTH UROLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-520-5888
Mailing Address - Street 1:4080 W BROADWAY AVE
Mailing Address - Street 2:SUITE #310
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5604
Mailing Address - Country:US
Mailing Address - Phone:763-520-5888
Mailing Address - Fax:763-520-5955
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:SUITE #310
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:763-520-5888
Practice Address - Fax:763-520-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN040181208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32722000Medicaid
18063TWOtherBLUE CROSS BLUE SHIELD
MN248645800Medicaid
339OtherHEALTHPARTNERS
MNCP8671OtherRAILROAD MEDICARE
0001OtherMEDICA CHOICE
0001OtherMEDICA PRIMARY
101378OtherUCARE
WI000009055Medicare PIN
339OtherHEALTHPARTNERS
G60335Medicare UPIN
MNC01138Medicare PIN
MNCP8671Medicare PIN