Provider Demographics
NPI:1942242714
Name:LOWCOUNTRY UROLOGY CLINICS PA
Entity Type:Organization
Organization Name:LOWCOUNTRY UROLOGY CLINICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-850-6120
Mailing Address - Street 1:2687 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9100
Mailing Address - Country:US
Mailing Address - Phone:843-572-0097
Mailing Address - Fax:843-725-3118
Practice Address - Street 1:2687 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9100
Practice Address - Country:US
Practice Address - Phone:843-572-0097
Practice Address - Fax:843-725-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4437Medicaid
SC8519Medicare PIN
SC6015540002Medicare NSC