Provider Demographics
NPI:1376537209
Name:LAURENS UROLOGICAL
Entity Type:Organization
Organization Name:LAURENS UROLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-938-0211
Mailing Address - Street 1:300 PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7557
Mailing Address - Country:US
Mailing Address - Phone:864-938-0211
Mailing Address - Fax:864-938-0135
Practice Address - Street 1:300 PLAZA CIR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7557
Practice Address - Country:US
Practice Address - Phone:864-938-0211
Practice Address - Fax:864-938-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2109Medicaid
SCGP2109Medicaid