Organization
EXECUTIVE UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT W RICE MD (PRESIDENT)
(419) 627-8771
Entity
Organization
Contact information
Practice address
290 PROGRESS DR, SUITE C, BELLEVUE, OH 44811-9099
(419) 484-1701
Mailing address
2800 HAYES AVE, BLDG D, SANDUSKY, OH 44870-7248
(419) 627-8771
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2282328
—
OH
01
—
CG9157
RAILROAD MEDICARE
OH
Enumeration date
03/24/2010
Last updated
03/24/2010
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