Provider Demographics
NPI:1467749523
Name:LEWIS & CLARK UROLOGY, LTD.
Entity Type:Organization
Organization Name:LEWIS & CLARK UROLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3193-313-2195
Mailing Address - Street 1:2525 FOX RUN PKWY
Mailing Address - Street 2:STE. 204
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5370
Mailing Address - Country:US
Mailing Address - Phone:605-260-0182
Mailing Address - Fax:605-668-0371
Practice Address - Street 1:2525 FOX RUN PKWY
Practice Address - Street 2:STE. 204
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5370
Practice Address - Country:US
Practice Address - Phone:605-260-0182
Practice Address - Fax:605-668-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty