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EDENTON UROLOGY CLINIC NPI 1578630398


NPI Information

NPI: 1578630398
Provider Name: EDENTON UROLOGY CLINIC
Classification: Urology - 208800000X
Entity Type: Organization
Address:
210 N BROAD ST
EDENTON, NC
ZIP 27932
Phone: (252) 482-1606
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EDENTON UROLOGY CLINIC is an urology in Edenton, NC. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. EDENTON UROLOGY CLINIC NPI is 1578630398. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

210 N BROAD ST
EDENTON, NC
ZIP 27932
Phone: (252) 482-1606
Fax: (252) 482-1611

The provider's authorized official is Joel Crist Reynolds .
The authorized official title is President and has the following contact phone number (252) 482-1606.

The enumeration date for this NPI number is 11/29/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208800000XUrology9900331NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10289TOTHERBCBS
2790289TMEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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