| Organization Name: | UMS UROLOGY SERVICES OF JEFFERSON COUNTY, LLC |
| NPI Number: | 1154784148 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGELA M. WALKER (BUSINESS MANAGER) |
| Mailing Address: | 1700 W Park Dr Suite 410 Westborough |
| State: | MA US |
| Postal Code: | 015813939 |
| Phone Number: | 4103565290 |
| Fax Number: | 4103565292 |
| NPI Enumeration Date: | 03/29/2016 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QL0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Lithotripsy |
| Taxonomy Definition: | |