Northwest Urology Center PS

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

NORTHWEST UROLOGY CENTER PS

Practice address

1624 S I St
Ste 204
Tacoma, WA 98405-5016

Phone

(253) 272-8441

Fax

(253) 272-8096

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Alia D Modarelli

Title

Office Administrator

Phone

(253) 272-8441

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Robert O Modarelli MD PS Former legal business name

Locations

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185840000000",
    "number": "1790846509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 S I ST",
            "address_2": "STE 204",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055016",
            "telephone_number": "253-272-8441",
            "fax_number": "253-272-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 S I ST",
            "address_2": "STE 204",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055016",
            "telephone_number": "253-272-8441",
            "fax_number": "253-272-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST UROLOGY CENTER PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-31",
        "status": "A",
        "authorized_official_last_name": "MODARELLI",
        "authorized_official_first_name": "ALIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "253-272-8441"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7077449",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Robert O Modarelli MD PS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Specialist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; 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.