Provider Demographics
NPI:1265842256
Name:W C THORNDYKE UROLOGY
Entity Type:Organization
Organization Name:W C THORNDYKE UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:THORNDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-4404
Mailing Address - Street 1:336 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1900
Mailing Address - Country:US
Mailing Address - Phone:606-324-4404
Mailing Address - Fax:606-325-6822
Practice Address - Street 1:336 29TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1900
Practice Address - Country:US
Practice Address - Phone:606-324-4404
Practice Address - Fax:606-325-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29406208800000X
KY363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102537Medicaid
KYK138140Medicare PIN