Provider Demographics
NPI:1962435529
Name:VIEWMONT UROLOGY CLINIC, PA
Entity type:Organization
Organization Name:VIEWMONT UROLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-322-4340
Mailing Address - Street 1:1202 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3760
Mailing Address - Country:US
Mailing Address - Phone:828-322-4340
Mailing Address - Fax:828-323-8450
Practice Address - Street 1:1202 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3760
Practice Address - Country:US
Practice Address - Phone:828-322-4340
Practice Address - Fax:828-323-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02874OtherGROUP BCBS NUMBER
NC8902874Medicaid
NC02874OtherGROUP BCBS NUMBER