Provider Demographics
NPI:1447395066
Name:CAROLINA UROLOGY PRACTICE
Entity Type:Organization
Organization Name:CAROLINA UROLOGY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWEAZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-796-8515
Mailing Address - Street 1:111 HOSPITAL DR W
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3405
Mailing Address - Country:US
Mailing Address - Phone:803-796-8515
Mailing Address - Fax:803-796-8516
Practice Address - Street 1:111 HOSPITAL DR W
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3405
Practice Address - Country:US
Practice Address - Phone:803-796-8515
Practice Address - Fax:803-796-8516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA UROLOGY PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2142Medicaid
SC5984Medicare ID - Type Unspecified