Provider Demographics
NPI:1194101899
Name:UROLOGY ASSOCIATES OF THE CENTRAL COAST
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES OF THE CENTRAL COAST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-786-2500
Mailing Address - Street 1:35 CASA ST STE 370
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5835
Mailing Address - Country:US
Mailing Address - Phone:805-541-1111
Mailing Address - Fax:805-544-0834
Practice Address - Street 1:35 CASA ST STE 370
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5835
Practice Address - Country:US
Practice Address - Phone:805-541-1111
Practice Address - Fax:805-544-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7179Medicare PIN