Provider Demographics
NPI:1699701292
Name:UROLOGY ASSOCIATES, LTD., P.S.
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES, LTD., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:PECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-456-4666
Mailing Address - Street 1:3525 ENSIGN RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-456-4666
Mailing Address - Fax:360-459-1566
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-456-4666
Practice Address - Fax:360-459-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019049208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA54181OtherLABOR AND INDUSTRY
WACS0195OtherRAILROAD MEDICARE
WA7744006Medicaid
WAT00395OtherREGENCE
WACS0195OtherRAILROAD MEDICARE
WA54181OtherLABOR AND INDUSTRY