Organization Active NPI

Urology Tyler, PA

  • Urology Physician
  • Tyler, TX
National Provider Identifier
1861572968
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
UROLOGY TYLER, PA
Practice address
700 Olympic Plaza Cir Ste 700
Tyler, TX 75701-1954
Phone
(903) 262-3900
Fax
(903) 262-3993
NPI assigned
Oct 16, 2006
Last updated
Aug 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

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

Authorized official

Name
Dr. Stanton P. Champion, MD
Title
President
Phone
(903) 262-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

700 Olympic Plaza Cir Ste 700
Tyler, TX 75701-1954

Mailing address

PO Box 8026
Tyler, TX 75711-8026
Phone (903) 262-3900

Other identifiers 1

IdentifierTypeStateIssuer
112852203MedicaidTX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0675621Uthet Urology Tyler700 Olympic Plaza Circle Suite 700, Tyler, TX 75701AccreditationSep 14, 2027

National Provider Directory

National Provider Directory

Locations

1017 E Idel St
Tyler, TX 75701
Phone (903) 590-5150

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1861572968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8026",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757118026",
            "telephone_number": "903-262-3900",
            "fax_number": "903-262-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 700",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011954",
            "telephone_number": "903-262-3900",
            "fax_number": "903-262-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY TYLER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2013-08-14",
        "status": "A",
        "authorized_official_last_name": "CHAMPION",
        "authorized_official_first_name": "STANTON",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-262-3900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112852203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.