Provider Demographics
NPI:1891753893
Name:ANDERSON UROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:ANDERSON UROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HINNANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD JD
Authorized Official - Phone:864-226-6131
Mailing Address - Street 1:112 ESSEX DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3319
Mailing Address - Country:US
Mailing Address - Phone:864-226-6131
Mailing Address - Fax:864-225-0830
Practice Address - Street 1:112 ESSEX DRIVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3319
Practice Address - Country:US
Practice Address - Phone:864-226-6131
Practice Address - Fax:864-225-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15856208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2184Medicaid
GA00593524BMedicaid
B23505Medicare UPIN
GA00593524BMedicaid