Provider Demographics
NPI:1174792642
Name:ATLANTIC UROLOGICAL ASSOCIATES P A
Entity type:Organization
Organization Name:ATLANTIC UROLOGICAL ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TEBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-4959
Mailing Address - Street 1:545 HEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1493
Mailing Address - Country:US
Mailing Address - Phone:386-239-8500
Mailing Address - Fax:386-274-7126
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:SUITE 140
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2380
Practice Address - Country:US
Practice Address - Phone:386-445-8530
Practice Address - Fax:386-446-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty