Provider Demographics
NPI:1023123270
Name:WESTERN CAROLINA UROLOGICAL ASSOC
Entity type:Organization
Organization Name:WESTERN CAROLINA UROLOGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-6262
Mailing Address - Street 1:1216 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-3312
Mailing Address - Country:US
Mailing Address - Phone:828-692-6262
Mailing Address - Fax:828-692-5858
Practice Address - Street 1:1216 6TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3312
Practice Address - Country:US
Practice Address - Phone:828-692-6262
Practice Address - Fax:828-692-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39774208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890227NMedicaid
NC890227NMedicaid
NC2344699Medicare PIN