Organization · NPI-2

Blue Ridge Urology Services LLC

Clinic/Center, Lithotripsy · Austin, TX

NPI number1144480419
StatusActive
Last updated in NPPESAug 15, 2008

Details

NPI
1144480419
Entity type
Organization (NPI-2)
Legal business name
Blue Ridge Urology Services LLC
Organization subpart
No
Enumeration date
Jun 11, 2008
Last updated
Aug 15, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QL0400X Clinic/Center, Lithotripsy––Yes

Practice location

1301 Capital Of Texas Highway
Suite B200
Austin, TX 78746-6574

Phone 512-314-4331

Mailing address

Po Box 847324
Dallas, TX 75284-7324

Authorized official

Theresa Davis
Director Cbo
5123144331

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