NPIMap

Organization Active NPI

Urology Group, PC

  • Urology Physician
  • Hayti, MO
National Provider Identifier
1154589901
Registry record updated Nov 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
119325 Issued in MO
Legal business name
UROLOGY GROUP, PC
Practice address
907 E Reed St
Hayti, MO 63851-1242
Phone
(901) 767-8158
NPI assigned
May 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deborah A Eddlestone
Title
Consultant
Phone
(901) 271-2272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 119325 MO Primary

Addresses

Primary practice location

907 E Reed St
Hayti, MO 63851-1242

Mailing address

907 E Reed St
Hayti, MO 63851-1242
Phone (901) 767-8158

Other identifiers 1

IdentifierTypeStateIssuer
000015398OtherMOMO MEDICARE GROUP NUMBER

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227571200000",
    "number": "1154589901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 E REED ST",
            "city": "HAYTI",
            "state": "MO",
            "postal_code": "638511242",
            "telephone_number": "901-767-8158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E REED ST",
            "city": "HAYTI",
            "state": "MO",
            "postal_code": "638511242",
            "telephone_number": "901-767-8158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-11-25",
        "status": "A",
        "authorized_official_last_name": "EDDLESTONE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "901-271-2272"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "MO",
            "license": "119325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO MEDICARE GROUP NUMBER",
            "identifier": "000015398",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayti, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.