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General NPI Number Information
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NPI Number | 1023123270
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Entity Type | Organization
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Legal Business Name | WESTERN CAROLINA UROLOGICAL ASSOC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 1216 6TH AVE W
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-3312
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Country | US
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Telephone | 828-692-6262
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Fax | 828-692-5858
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Provider Business Mailing Address
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Address Line | 1216 6TH AVE W
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-3312
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Country | US
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Telephone | 828-692-6262
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Fax | 828-692-5858
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. STEPHANIE AUSTIN
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Credential |
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Telephone | 828-692-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 39774
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License Number State | NC
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