Organization
CLEVELAND UROLOGIC SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEM K BLACKLEY III M.D. (PARTNER)
(704) 482-2011
Entity
Organization
Contact information
Practice address
1001 N WASHINGTON ST, SHELBY, NC 28150-1800
(704) 482-2011
(704) 484-0303
Mailing address
PO BOX 1029, SHELBY, NC 28151-1029
(704) 482-2011
(704) 484-0303
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230126
MEDICARE PTAN
NC
Enumeration date
08/19/2006
Last updated
01/27/2010
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