Organization
SMOKY MOUNTAIN UROLOGY, INC
Active
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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