Healthcare Provider Details

I. General information

NPI: 1518963164
Provider Name (Legal Business Name): FOOTHILLS UROLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 TRYON RD STE B
RUTHERFORDTON NC
28139-3099
US

IV. Provider business mailing address

141 TRYON RD STE B
RUTHERFORDTON NC
28139-3099
US

V. Phone/Fax

Practice location:
  • Phone: 828-286-1445
  • Fax: 828-286-1443
Mailing address:
  • Phone: 828-286-1445
  • Fax: 828-286-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberN/A
License Number StateNC

VIII. Authorized Official

Name: WILLIAM STEWART POWELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 828-286-1445