Organization
NORTHWEST COLUMBUS UROLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY S KNUDSON M.D. (PRESIDENT)
(937) 644-5240
Entity
Organization
Contact information
Practice address
498 LONDON AVE, SUITE H, MARYSVILLE, OH 43040-5512
(937) 644-5240
(937) 644-3754
Mailing address
498 LONDON AVE, SUITE H, MARYSVILLE, OH 43040-5512
(937) 644-5240
(937) 644-3754
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
35055629
OH
174400000X
Specialist
Primary
35063160
OH
174400000X
Specialist
35069365
OH
174400000X
Specialist
35069608
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0885127
—
OH
01
—
5195371
AETNA
—
01
—
CL2354
RR MEDICARE
—
Enumeration date
11/22/2006
Last updated
01/09/2008
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