Provider Demographics
NPI:1912081878
Name:UROLOGY ONE INC
Entity type:Organization
Organization Name:UROLOGY ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BECHARA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TABET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-456-6760
Mailing Address - Street 1:1330 MERCY DR NW STE 510
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2625
Mailing Address - Country:US
Mailing Address - Phone:330-456-6760
Mailing Address - Fax:330-452-4557
Practice Address - Street 1:1330 MERCY DR NW STE 510
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-456-6760
Practice Address - Fax:330-452-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2313204Medicaid
OH2556818Medicaid
OH2312929Medicaid
CJ7684OtherRR MCR GROUP
OH2312910Medicaid
OH2312938Medicaid
OH2332845Medicaid
OH2556827Medicaid
9322245Medicare ID - Type UnspecifiedGROUP
OH2312929Medicaid
9322246Medicare ID - Type UnspecifiedGROUP
9322241Medicare ID - Type UnspecifiedGROUP
OH2556827Medicaid
OH2312938Medicaid
9322247Medicare ID - Type UnspecifiedGROUP