Provider Demographics
NPI:1245596519
Name:KEOWEE FAMILY UROLOGY
Entity Type:Organization
Organization Name:KEOWEE FAMILY UROLOGY
Other - Org Name:KEOWEE FAMILY UROLOGY DME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-885-7673
Mailing Address - Street 1:PO BOX 601082
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1082
Mailing Address - Country:US
Mailing Address - Phone:864-885-7989
Mailing Address - Fax:864-885-7867
Practice Address - Street 1:107 OMNI DR
Practice Address - Street 2:SUITE A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9448
Practice Address - Country:US
Practice Address - Phone:864-885-7475
Practice Address - Fax:864-885-7476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCONEE PHYSICIAN PRACTICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies