Provider Demographics
NPI:1437330586
Name:CARGILL UROLOGY CORPORATION
Entity Type:Organization
Organization Name:CARGILL UROLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-634-5000
Mailing Address - Street 1:101 CLEVELAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3700
Mailing Address - Country:US
Mailing Address - Phone:276-634-5000
Mailing Address - Fax:276-634-5229
Practice Address - Street 1:101 CLEVELAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3700
Practice Address - Country:US
Practice Address - Phone:276-634-5000
Practice Address - Fax:276-634-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036744208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB08209Medicare UPIN
VA4530350001Medicare NSC
VAC08143Medicare PIN