Provider Demographics
NPI:1124472246
Name:APP UROLOGY CLINIC
Entity type:Organization
Organization Name:APP UROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-789-4916
Mailing Address - Street 1:PO BOX 748157
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-8157
Mailing Address - Country:US
Mailing Address - Phone:541-789-5250
Mailing Address - Fax:541-789-5538
Practice Address - Street 1:537 UNION AVE
Practice Address - Street 2:SECOND FLOOR 2B
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5543
Practice Address - Country:US
Practice Address - Phone:541-507-2020
Practice Address - Fax:541-507-2021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASANTE PHYSICIAN PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty