Provider Demographics
NPI:1164448247
Name:CENTER FOR UROLOGICAL DISEASES AT LANCASTER
Entity Type:Organization
Organization Name:CENTER FOR UROLOGICAL DISEASES AT LANCASTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-416-8300
Mailing Address - Street 1:838 W MEETING ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6233
Mailing Address - Country:US
Mailing Address - Phone:803-416-8300
Mailing Address - Fax:803-416-8303
Practice Address - Street 1:838 W MEETING ST
Practice Address - Street 2:SUITE E
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6233
Practice Address - Country:US
Practice Address - Phone:803-416-8300
Practice Address - Fax:803-416-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19913208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2381Medicaid
SCGP2381Medicaid
SC6239Medicare ID - Type Unspecified
SCG35962Medicare UPIN