Provider Demographics
NPI:1023091691
Name:SALISBURY UROLOGICAL CLINIC, PA
Entity type:Organization
Organization Name:SALISBURY UROLOGICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:704-633-9441
Mailing Address - Street 1:911 W HENDERSON ST
Mailing Address - Street 2:STE 110
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2736
Mailing Address - Country:US
Mailing Address - Phone:704-633-9441
Mailing Address - Fax:704-637-9006
Practice Address - Street 1:911 W HENDERSON ST
Practice Address - Street 2:STE 110
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2736
Practice Address - Country:US
Practice Address - Phone:704-633-9441
Practice Address - Fax:704-637-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
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
NC8902595Medicaid
NC8902595Medicaid