Basic Information
| Provider Information | |||||||||
| NPI: | 1043578859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWOODS UROLOGY OF TEXAS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 VISION PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773843001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814043000 | ||||||||
| FaxNumber: | 9362736911 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 VISION PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773843001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814043000 | ||||||||
| FaxNumber: | 9362736911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2012 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | KENWORTHY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2814043000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.