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General NPI Number Information
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NPI Number | 1467749523
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Entity Type | Organization
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Legal Business Name | LEWIS & CLARK UROLOGY, LTD.
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 2525 FOX RUN PKWY STE. 204
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City | YANKTON
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State | SD
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Zip | 57078-5370
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Country | US
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Telephone | 605-260-0182
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Fax | 605-668-0371
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Provider Business Mailing Address
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Address Line | 2525 FOX RUN PKWY STE. 204
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City | YANKTON
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State | SD
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Zip | 57078-5370
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Country | US
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Telephone | 605-260-0182
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Fax | 605-668-0371
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER A HATHAWAY
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Credential | MD
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Telephone | 31933132195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 7809
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License Number State | SD
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