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Contact Information

EDENTON UROLOGY CLINIC
210 N BROAD ST
EDENTON, NC27932
 Phone: 252-482-1606
 Fax: 252-482-1611
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Urology

208800000X 34 Physician/Urology
Indicates primary specialty

NPI Profile & details for EDENTON UROLOGY CLINIC

NPI Number 1578630398
LBN Legal business name EDENTON UROLOGY CLINIC
Authorized official JOEL REYNOLDS - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 11/29/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
NC License # 9900331
NC Medicaid 790289T
Other 0289T BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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