Provider Demographics
NPI:1063439826
Name:UROLOGY SPECIALTY CARE, PSC
Entity type:Organization
Organization Name:UROLOGY SPECIALTY CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-821-7739
Mailing Address - Street 1:1851 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431
Mailing Address - Country:US
Mailing Address - Phone:270-821-7739
Mailing Address - Fax:270-821-0278
Practice Address - Street 1:1851 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:270-821-7739
Practice Address - Fax:270-821-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35189208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty