Provider Demographics
NPI:1962417535
Name:ADVANCED UROLOGY INC
Entity type:Organization
Organization Name:ADVANCED UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-9787
Mailing Address - Street 1:PO BOX 76526
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-6500
Mailing Address - Country:US
Mailing Address - Phone:330-758-9787
Mailing Address - Fax:330-758-9792
Practice Address - Street 1:904 SAHARA TRAIL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-758-9787
Practice Address - Fax:330-758-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2092711Medicaid
OH0170998Medicaid
OH2011183Medicaid
CA7425OtherRAILROAD MEDICARE
OH2092711Medicaid
OH0170998Medicaid
OH9279112Medicare PIN