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Organization

SMOKY MOUNTAIN UROLOGY, INC

Active
Parent organization
SMOKY MOUNTAIN UROLOGY, INC
Organization subpart
Yes

Provider details

NPI number
Legal business name
SMOKY MOUNTAIN UROLOGY, INC
Authorized official
DR. RUSTAN JOEL VAN WYK D.O. (CEO)
(828) 698-0896
Entity
Organization

Contact information

Practice address
1334 ASHEVILLE HWY, HENDERSONVILLE, NC 28791-3414
(828) 698-0896
(828) 698-9532
Mailing address
1334 ASHEVILLE HWY, HENDERSONVILLE, NC 28791-3414
(828) 698-0896
(828) 698-9532

Taxonomy

Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
BV7069330
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
89128F6
NC
Enumeration date
04/22/2011
Last updated
04/22/2011
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