Provider Demographics
NPI:1659470169
Name:BOONE UROLOGY CENTER, P.A.
Entity Type:Organization
Organization Name:BOONE UROLOGY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-264-5150
Mailing Address - Street 1:935 STATE FARM RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4948
Mailing Address - Country:US
Mailing Address - Phone:828-264-5150
Mailing Address - Fax:828-265-3611
Practice Address - Street 1:935 STATE FARM RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4948
Practice Address - Country:US
Practice Address - Phone:828-264-5150
Practice Address - Fax:828-265-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0102POtherBLUE CROSS GROUP #
NC2311265Medicare PIN
NC0102POtherBLUE CROSS GROUP #