Organization
UROLOGY GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH A EDDLESTONE (CONSULTANT)
(901) 271-2272
Entity
Organization
Contact information
Practice address
907 E REED ST, HAYTI, MO 63851-1242
(901) 767-8158
Mailing address
907 E REED ST, HAYTI, MO 63851-1242
(901) 767-8158
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
119325
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015398
MO MEDICARE GROUP NUMBER
MO
Enumeration date
05/29/2008
Last updated
11/25/2008
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