MEDICARE: FOOTHILLS UROLOGY, P.A.

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	N/A	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518963164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS UROLOGY, P.A.

Provider Business Mailing Address
First Line	:	141 TRYON RD
Second Line	:	STE B
City	:	RUTHERFORDTON
State	:	NC
Zip	:	28139-3099
Country	:	US
Telephone Number	:	828-286-1445
Fax Number	:	828-286-1443

Provider Business Practice Location Address
First Line	:	141 TRYON RD
Second Line	:	STE B
City	:	RUTHERFORDTON
State	:	NC
Zip	:	28139-3099
Country	:	US
Telephone Number	:	828-286-1445
Fax Number	:	828-286-1443

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM STEWART POWELL
Credential	:	M.D.
Telephone Number	:	828-286-1445

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	12/08/2009

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