Provider Demographics
NPI:1558373597
Name:COLUMBIA UROLOGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:COLUMBIA UROLOGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:HERLONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-254-4591
Mailing Address - Street 1:1301 TAYLOR ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2942
Mailing Address - Country:US
Mailing Address - Phone:803-254-4591
Mailing Address - Fax:803-931-8000
Practice Address - Street 1:1301 TAYLOR ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2942
Practice Address - Country:US
Practice Address - Phone:803-254-4591
Practice Address - Fax:803-931-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1391Medicaid
SC1320Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER