Provider Demographics
NPI:1962274977
Name:BTX PREMIER UROLOGY PA
Entity type:Organization
Organization Name:BTX PREMIER UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:EWANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-255-5010
Mailing Address - Street 1:PO BOX 4948
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4948
Mailing Address - Country:US
Mailing Address - Phone:956-255-5010
Mailing Address - Fax:
Practice Address - Street 1:800 W JEFFERSON ST STE 170
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6300
Practice Address - Country:US
Practice Address - Phone:956-255-5010
Practice Address - Fax:956-255-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty