Provider Demographics
NPI:1992916316
Name:LIMA UROLOGY INC
Entity type:Organization
Organization Name:LIMA UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-228-8950
Mailing Address - Street 1:770 WEST HIGH STREET
Mailing Address - Street 2:SUIT 350
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5901
Mailing Address - Country:US
Mailing Address - Phone:419-228-8950
Mailing Address - Fax:419-224-7904
Practice Address - Street 1:770 WEST HIGH STREET
Practice Address - Street 2:SUIT 350
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5901
Practice Address - Country:US
Practice Address - Phone:419-228-8950
Practice Address - Fax:419-224-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2206759Medicaid
OHCB3829OtherRAILROAD MEDICARE
OH2206759Medicaid