Organization
UNIVERSITY UROLOGICAL ASSOCIATES, INC.
Active
Parent organization
UNIVERSTIY UROLOGICAL ASSOCIATES, INC.
Other names
Collyer Street Operatory
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSTIY UROLOGICAL ASSOCIATES, INC.
Authorized official
MS. MICHELLE R DEROCHE (PRACTICE ADMINISTRATOR)
(401) 276-2001
Entity
Organization
Contact information
Practice address
195 COLLYER ST, SUITE 201, PROVIDENCE, RI 02904-1869
(401) 276-2026
(401) 276-2025
Mailing address
195 COLLYER STREET, SUITE 201, PROVIDENCE, RI 02904
(401) 276-2026
(401) 276-2025
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
PHS00006
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000005723
BLUE CROSS BLUE SHIELD
RI
Enumeration date
04/17/2007
Last updated
09/18/2014
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