Provider Demographics
NPI:1013970136
Name:ROCKY MOUNT UROLOGY ASSOC PA
Entity Type:Organization
Organization Name:ROCKY MOUNT UROLOGY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:CREECH
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-443-3136
Mailing Address - Street 1:180 FOY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2417
Mailing Address - Country:US
Mailing Address - Phone:252-443-3136
Mailing Address - Fax:252-443-3847
Practice Address - Street 1:180 FOY DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2417
Practice Address - Country:US
Practice Address - Phone:252-443-3136
Practice Address - Fax:252-443-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901550Medicaid
NC0514420001OtherMEDICARE PTAN
NC0514420001Medicare NSC
NC230106Medicare ID - Type Unspecified