Organization Active NPI

Kanawha Urology Associates Inc

  • Urology Physician
  • South Charleston, WV
National Provider Identifier
1174637862
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
KANAWHA UROLOGY ASSOCIATES INC
Practice address
400 Division Street
Ste 6
South Charleston, WV 25309-1459
Phone
(304) 768-7368
Fax
(304) 768-1829
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Henry Mani, MDNPI 1548374234
Title
President
Phone
(304) 768-7368

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

400 Division Street
Ste 6
South Charleston, WV 25309-1459

Mailing address

400 Division Street
Ste 6
South Charleston, WV 25309-1459
Phone (304) 768-7368

Other identifiers 1

IdentifierTypeStateIssuer
5580094000MedicaidWV

National Provider Directory

National Provider Directory

Locations

4610 Kanawha Ave SW
Ste 401
South Charleston, WV 25309
Phone (304) 768-7368

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174637862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 DIVISION STREET",
            "address_2": "STE 6",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091459",
            "telephone_number": "304-768-7368",
            "fax_number": "304-768-1829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 DIVISION STREET",
            "address_2": "STE 6",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091459",
            "telephone_number": "304-768-7368",
            "fax_number": "304-768-1829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANAWHA UROLOGY ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-768-7368",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5580094000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.