Provider Demographics
NPI:1588718969
Name:ONSLOW UROLOGY CLINIC
Entity type:Organization
Organization Name:ONSLOW UROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:HAMMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-353-9994
Mailing Address - Street 1:200 DOCTORS DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6308
Mailing Address - Country:US
Mailing Address - Phone:910-353-9994
Mailing Address - Fax:919-353-5784
Practice Address - Street 1:200 DOCTORS DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-353-9994
Practice Address - Fax:919-353-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26107208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902344Medicaid
NC02344OtherBCBS
NC7902344Medicaid
NC02344OtherBCBS