Provider Demographics
NPI:1053562033
Name:KS UROLOGY INC
Entity type:Organization
Organization Name:KS UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD,
Authorized Official - Phone:419-228-0570
Mailing Address - Street 1:1220 E ELM ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2850
Mailing Address - Country:US
Mailing Address - Phone:419-228-0570
Mailing Address - Fax:419-228-0943
Practice Address - Street 1:1220 E ELM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2850
Practice Address - Country:US
Practice Address - Phone:419-228-0570
Practice Address - Fax:419-228-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057809S208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000027893OtherANTHEM BLUE CROSS & BLUE SHIELD
OH0989757Medicaid
OH340008614OtherRAILROAD MEDICARE
F61317Medicare UPIN
OH0766681Medicare PIN