Provider Demographics
NPI:1598997371
Name:CAROLINA UROLOGY HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:CAROLINA UROLOGY HEALTHCARE, PLLC
Other - Org Name:SAMPSON UROLOGY ASSOCIATES, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-590-3569
Mailing Address - Street 1:1021 BEAMAN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4001
Mailing Address - Country:US
Mailing Address - Phone:910-590-3569
Mailing Address - Fax:910-592-3525
Practice Address - Street 1:1021 BEAMAN STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4001
Practice Address - Country:US
Practice Address - Phone:910-590-3569
Practice Address - Fax:910-592-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300399208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134K7Medicaid
H84298Medicare UPIN
2016227AMedicare PIN