MEDICARE: HIFU PROSTATE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1427563725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIFU PROSTATE SERVICES, LLC

Provider Business Mailing Address
First Line	:	4108 PARK RD STE 205
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2260
Country	:	US
Telephone Number	:	704-248-7562
Fax Number	:	866-437-8028

Provider Business Practice Location Address
First Line	:	4108 PARK RD STE 205
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2260
Country	:	US
Telephone Number	:	704-248-7562
Fax Number	:	866-437-8028

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN W LINN
Credential	:
Telephone Number	:	704-248-7562

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	12/08/2017

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