Provider Demographics
NPI:1598045866
Name:LEWIS & CLARK UROLOGY, LTD.
Entity type:Organization
Organization Name:LEWIS & CLARK UROLOGY, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-260-0182
Mailing Address - Street 1:409 SUMMIT ST
Mailing Address - Street 2:SUITE 33400
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3734
Mailing Address - Country:US
Mailing Address - Phone:605-260-0182
Mailing Address - Fax:
Practice Address - Street 1:301 N 27TH ST
Practice Address - Street 2:STE10
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4401
Practice Address - Country:US
Practice Address - Phone:605-260-0182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25714208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty