Provider Demographics
NPI:1831290451
Name:UROLOGY CLINIC OF WINCHESTER, P.C.
Entity Type:Organization
Organization Name:UROLOGY CLINIC OF WINCHESTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:HILLYARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:540-667-1712
Mailing Address - Street 1:1712 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2807
Mailing Address - Country:US
Mailing Address - Phone:540-677-1712
Mailing Address - Fax:540-665-0045
Practice Address - Street 1:1712 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2807
Practice Address - Country:US
Practice Address - Phone:540-677-1712
Practice Address - Fax:540-665-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01622Medicare ID - Type Unspecified