Organization
VIRTUAL URODYNAMICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARRIE LYNN CARDA (OWNER)
(573) 776-7393
Entity
Organization
Contact information
Practice address
2340 KATY LN, POPLAR BLUFF, MO 63901-2300
(573) 776-7393
(573) 776-7396
Mailing address
2340 KATY LN, POPLAR BLUFF, MO 63901-2300
(573) 776-7393
(573) 776-7396
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD111753
MO
208800000X
Urology Physician
MD111753
MO
261QM2500X
Medical Specialty Clinic/Center
Primary
MD111753
MO
Other
Enumeration date
04/11/2011
Last updated
04/11/2011
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