Provider Demographics
NPI:1699875377
Name:KITSAP UROLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:KITSAP UROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-377-0049
Mailing Address - Street 1:2500 CHERRY AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4202
Mailing Address - Country:US
Mailing Address - Phone:360-377-0049
Mailing Address - Fax:360-792-0446
Practice Address - Street 1:2500 CHERRY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4202
Practice Address - Country:US
Practice Address - Phone:360-377-0049
Practice Address - Fax:360-792-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023945208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty