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General NPI Number Information
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NPI Number | 1326153677
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Entity Type | Organization
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Legal Business Name | CLEVELAND UROLOGIC SURGERY, PA
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 1001 N WASHINGTON ST
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City | SHELBY
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State | NC
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Zip | 28150-1800
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Country | US
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Telephone | 704-482-2011
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Fax | 704-484-0303
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Provider Business Mailing Address
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Address Line | PO BOX 1029
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City | SHELBY
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State | NC
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Zip | 28151-1029
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Country | US
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Telephone | 704-482-2011
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Fax | 704-484-0303
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Authorized Official
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Title or Position | PARTNER
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Name | SHEM K BLACKLEY III
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Credential | M.D.
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Telephone | 704-482-2011
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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 |
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License Number State |
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