Provider Demographics
NPI:1730223199
Name:ADVANCED UROLOGY INSTITUTE, LLC
Entity type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-391-6494
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-391-6494
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:80 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4517
Practice Address - Country:US
Practice Address - Phone:850-785-8557
Practice Address - Fax:850-785-3497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED UROLOGY INSTITUTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-19
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7242550004Medicare NSC
FLHS558BMedicare PIN
FLHS558AMedicare PIN
FLG02340Medicare UPIN
FLH64834Medicare UPIN
FLP93978Medicare UPIN
FL18446ZMedicare PIN
FL43670ZMedicare PIN
FLU2411ZMedicare PIN
FLG87430Medicare UPIN
FL71740ZMedicare PIN
FLF49333Medicare UPIN
FLS77669Medicare UPIN
FLE2334ZMedicare PIN
FLH91099Medicare UPIN
FLQ13246Medicare UPIN
FL1165410001Medicare NSC
FL35766ZMedicare PIN
FLC81416Medicare UPIN