Active NPI
Smoky Mountain Urology, Inc
- Non-Pharmacy Dispensing Site
- Hendersonville, NC
National Provider Identifier
1588955744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Non-Pharmacy Dispensing Site
- License
- BV7069330
- Legal business name
- SMOKY MOUNTAIN UROLOGY, INC
- Practice address
- 1334 Asheville Hwy
Hendersonville, NC 28791-3414 - Phone
- (828) 698-0896
- Fax
- (828) 698-9532
- NPI assigned
- Apr 22, 2011
- Organization subpart
- Yes
- Parent organization
- SMOKY MOUNTAIN UROLOGY, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Rustan Joel Van Wyk, D.O.
- Title
- Ceo
- Phone
- (828) 698-0896
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-Pharmacy Dispensing Site | 332900000X | BV7069330 | NC | Primary |
Addresses
Primary practice location
1334 Asheville Hwy
Hendersonville, NC 28791-3414
Mailing address
1334 Asheville Hwy
Hendersonville, NC 28791-3414
Phone (828) 698-0896
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89128F6 | Medicaid | NC |
National Provider Directory
National Provider Directory- Part of
- Smoky Mountain Urological Inc
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Urology Physician
- Greenville, NC
- NPI 1861474439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303430400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1303430400000",
"number": "1588955744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1334 ASHEVILLE HWY",
"city": "HENDERSONVILLE",
"state": "NC",
"postal_code": "287913414",
"telephone_number": "828-698-0896",
"fax_number": "828-698-9532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1334 ASHEVILLE HWY",
"city": "HENDERSONVILLE",
"state": "NC",
"postal_code": "287913414",
"telephone_number": "828-698-0896",
"fax_number": "828-698-9532"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SMOKY MOUNTAIN UROLOGY, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SMOKY MOUNTAIN UROLOGY, INC",
"enumeration_date": "2011-04-22",
"last_updated": "2011-04-22",
"status": "A",
"authorized_official_last_name": "VAN WYK",
"authorized_official_first_name": "RUSTAN",
"authorized_official_middle_name": "JOEL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "828-698-0896",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.O."
},
"taxonomies": [
{
"code": "332900000X",
"taxonomy_group": "",
"desc": "Non-Pharmacy Dispensing Site",
"state": "NC",
"license": "BV7069330",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89128F6",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hendersonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.