Provider Demographics
NPI:1730106709
Name:LUMBERTON UROLOGY CLINIC, P.A.
Entity Type:Organization
Organization Name:LUMBERTON UROLOGY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HILBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-7166
Mailing Address - Street 1:815 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2330
Mailing Address - Country:US
Mailing Address - Phone:910-738-7166
Mailing Address - Fax:910-738-4434
Practice Address - Street 1:815 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2330
Practice Address - Country:US
Practice Address - Phone:910-738-7166
Practice Address - Fax:910-738-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902848Medicaid
NC8902848Medicaid