Provider Demographics
NPI:1073676052
Name:UROLOGY CLINIC P.C.
Entity type:Organization
Organization Name:UROLOGY CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VANOVEREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-871-9710
Mailing Address - Street 1:501 ANGLERS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8841
Mailing Address - Country:US
Mailing Address - Phone:970-871-9710
Mailing Address - Fax:970-871-9709
Practice Address - Street 1:501 ANGLERS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8840
Practice Address - Country:US
Practice Address - Phone:970-871-9710
Practice Address - Fax:970-871-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87877767Medicaid
CO87877767Medicaid