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General NPI Number Information
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NPI Number | 1083641039
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Entity Type | Organization
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Legal Business Name | BIG SANDY UROLOGY PSC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 2489 HWY 644 SUITE 202
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-1311
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Fax | 606-638-3739
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Provider Business Mailing Address
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Address Line | PO BOX 569
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City | LOUISA
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State | KY
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Zip | 41230-0569
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Country | US
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Telephone | 606-638-1311
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Fax | 606-638-3739
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM CHARLES THORNDYKE
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Credential | MDCM FRCS
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Telephone | 606-638-1311
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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 | 29406
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License Number State | KY
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