Provider Demographics
NPI:1669404208
Name:UROLOGY SPECIALISTS OF THE CAROLINAS PLLC
Entity type:Organization
Organization Name:UROLOGY SPECIALISTS OF THE CAROLINAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-248-3400
Mailing Address - Street 1:1518 EAST 3RD STREET
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6488
Mailing Address - Country:US
Mailing Address - Phone:704-248-3400
Mailing Address - Fax:704-337-8387
Practice Address - Street 1:325 HAWTHORNE LN STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2433
Practice Address - Country:US
Practice Address - Phone:704-372-5180
Practice Address - Fax:704-376-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0279UOtherBLUE CROSS BLUE SHIELD
NCCF9758OtherRAILROAD MEDICARE PROV#
NC5903371Medicaid
NCCF9758OtherRAILROAD MEDICARE PROV#
FLK8447Medicare ID - Type UnspecifiedMEDICARE GROUP #
NC2343734CMedicare ID - Type Unspecified
NC2343734BMedicare ID - Type Unspecified
NC5903371Medicaid