Organization
KS UROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH E STANLEY III M.D., (VICE PRESIDENT)
(419) 228-0570
Entity
Organization
Contact information
Practice address
1220 E ELM ST, SUITE 101, LIMA, OH 45804-2850
(419) 228-0570
(419) 228-0943
Mailing address
1220 E ELM ST, SUITE 101, LIMA, OH 45804-2850
(419) 228-0570
(419) 228-0943
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35057809S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000027893
ANTHEM BLUE CROSS & BLUE SHIELD
OH
05
—
0989757
—
OH
01
—
340008614
RAILROAD MEDICARE
OH
Enumeration date
10/08/2008
Last updated
10/08/2008
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