Provider Demographics
NPI:1194078535
Name:UROSOURCE MEDICAL LLC
Entity type:Organization
Organization Name:UROSOURCE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-742-3387
Mailing Address - Street 1:5350 S PEORIA AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6820
Mailing Address - Country:US
Mailing Address - Phone:918-742-3387
Mailing Address - Fax:918-745-6019
Practice Address - Street 1:5350 S PEORIA AVE
Practice Address - Street 2:SUITE L
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6820
Practice Address - Country:US
Practice Address - Phone:918-742-3387
Practice Address - Fax:918-745-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies