Provider Demographics
NPI:1447383047
Name:MOUNTAIN REGIONAL UROLOGY
Entity Type:Organization
Organization Name:MOUNTAIN REGIONAL UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DEHOLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-369-4283
Mailing Address - Street 1:2 GRAYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1320
Mailing Address - Country:US
Mailing Address - Phone:828-350-8592
Mailing Address - Fax:828-225-6886
Practice Address - Street 1:2 GRAYSTONE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1320
Practice Address - Country:US
Practice Address - Phone:828-350-8592
Practice Address - Fax:828-225-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700526208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891049JMedicaid
NC2238261Medicare ID - Type Unspecified
NC891049JMedicaid