Provider Demographics
NPI:1306935341
Name:UROLOGY GROUP OF PADUCAH, P.S.C.
Entity type:Organization
Organization Name:UROLOGY GROUP OF PADUCAH, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-442-3539
Mailing Address - Street 1:2603 KENTUCKY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3814
Mailing Address - Country:US
Mailing Address - Phone:270-442-3539
Mailing Address - Fax:270-442-2051
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3818
Practice Address - Country:US
Practice Address - Phone:270-442-3539
Practice Address - Fax:270-442-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0152170001OtherMEDICARE DMERC