Provider Demographics
NPI:1578753588
Name:PIEDMONT UROLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PIEDMONT UROLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GEHRKEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
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:2007-07-26
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADP0279OtherRR MEDICARE
VA1831243542Medicaid
VA1396799318Medicaid
VA6217150001Medicare NSC