Provider Demographics
NPI:1346204393
Name:OCONEE UROLOGY, P.A.
Entity Type:Organization
Organization Name:OCONEE UROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GOODING
Authorized Official - Last Name:MCALPINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-882-5306
Mailing Address - Street 1:P.O. BOX 699
Mailing Address - Street 2:STE B
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-0699
Mailing Address - Country:US
Mailing Address - Phone:864-882-5306
Mailing Address - Fax:864-882-1908
Practice Address - Street 1:135 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:STE B
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2558
Practice Address - Country:US
Practice Address - Phone:864-882-5306
Practice Address - Fax:864-882-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC3171Medicaid
SC1856Medicare PIN
SCPC3171Medicaid