=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982794970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROLOGY ASSOCIATES, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 04/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 HIGHLAND AVE SE SUITE 105
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24013-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-343-8066
-----------------------------------------------------
Fax | 540-343-5369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 HIGHLAND AVE SE SUITE 105
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24013-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-343-8066
-----------------------------------------------------
Fax | 540-343-5369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT ANDREW WHISNANT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 540-343-8066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------