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General NPI Number Information
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NPI Number | 1598045866
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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 | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 301 N 27TH ST STE10
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City | NORFOLK
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State | NE
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Zip | 68701-4401
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Country | US
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Telephone | 605-260-0182
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Fax |
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Provider Business Mailing Address
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Address Line | 409 SUMMIT ST SUITE 33400
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City | YANKTON
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State | SD
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Zip | 57078-3734
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Country | US
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Telephone | 605-260-0182
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER ALAN HATHAWAY
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Credential | MD
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Telephone | 605-260-0182
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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 | 25714
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License Number State | NE
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