Provider Demographics
NPI:1861410649
Name:CENTER FOR UROLOGIC HEALTH, LLC
Entity type:Organization
Organization Name:CENTER FOR UROLOGIC HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DANESIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-835-5584
Mailing Address - Street 1:320 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1709
Mailing Address - Country:US
Mailing Address - Phone:330-376-8626
Mailing Address - Fax:330-374-1180
Practice Address - Street 1:320 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1709
Practice Address - Country:US
Practice Address - Phone:330-376-8626
Practice Address - Fax:330-374-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2638542Medicaid
OH2638542Medicaid