Provider Demographics
NPI:1174500532
Name:UROLOGY CENTER OF THE MIDLANDS
Entity Type:Organization
Organization Name:UROLOGY CENTER OF THE MIDLANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-276-1822
Mailing Address - Street 1:2616 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-4002
Mailing Address - Country:US
Mailing Address - Phone:803-276-1822
Mailing Address - Fax:803-276-1832
Practice Address - Street 1:2616 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-4002
Practice Address - Country:US
Practice Address - Phone:803-276-1822
Practice Address - Fax:803-276-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC917208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009172Medicaid
SC009172Medicaid
SC8363Medicare PIN
SC54453Medicare UPIN