Provider Demographics
NPI:1871676106
Name:WEST OHIO UROLOGY ASSOCIATES, INC
Entity type:Organization
Organization Name:WEST OHIO UROLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FRCS
Authorized Official - Phone:419-422-5646
Mailing Address - Street 1:2728 FOXFIRE LN
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7138
Mailing Address - Country:US
Mailing Address - Phone:419-422-3377
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1304
Practice Address - Country:US
Practice Address - Phone:419-422-5646
Practice Address - Fax:419-422-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-045878208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212317Medicaid
000000140324OtherANTHEM BCBS
1309147OtherHIGHMARK BCBS
OH36D0351656OtherCLIA
OH000000168601OtherANTHEM FEDERAL
232089491003OtherMEDICAL MUTUAL OF OHIO
1096780001OtherADMINISTAR
340014692OtherRAILROAD MEDICARE
OH9294731OtherMEDICARE GROUP
OH6218555OtherCIGNA
000000140324OtherANTHEM BCBS
000000140324OtherANTHEM BCBS
OH=========OtherTAX ID
OHA15384Medicare UPIN