Provider Demographics
NPI:1871606954
Name:OAKWOOD UROLOGY CLINIC PC
Entity type:Organization
Organization Name:OAKWOOD UROLOGY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-669-9100
Mailing Address - Street 1:1647 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-669-9100
Mailing Address - Fax:
Practice Address - Street 1:1647 E 18TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4209
Practice Address - Country:US
Practice Address - Phone:970-669-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23635208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01236355Medicaid
CO01287606Medicaid
CO29939232Medicaid
CO29939232Medicaid
E54811Medicare UPIN
456238Medicare ID - Type Unspecified
CL5818Medicare ID - Type Unspecified
CL5828Medicare ID - Type Unspecified
CO01287606Medicaid