Provider Demographics
NPI:1235295577
Name:THE UROLOGY CENTER, PLLC
Entity type:Organization
Organization Name:THE UROLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER UROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-848-0844
Mailing Address - Street 1:9 CHENOWETH DR # B
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1675
Mailing Address - Country:US
Mailing Address - Phone:304-848-0844
Mailing Address - Fax:304-848-0375
Practice Address - Street 1:9 CHENOWETH DR # B
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1675
Practice Address - Country:US
Practice Address - Phone:304-848-0844
Practice Address - Fax:304-848-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21951208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDE1153OtherRAILROAD MEDICARE
WVDE1153OtherRAILROAD MEDICARE