Provider Demographics
NPI:1669437083
Name:UPSTATE UROLOGY AND ASSOCIATES, P.A.
Entity type:Organization
Organization Name:UPSTATE UROLOGY AND ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-295-1031
Mailing Address - Street 1:8 MEMORIAL MEDICAL CT
Mailing Address - Street 2:STE. 6
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4455
Mailing Address - Country:US
Mailing Address - Phone:864-295-1031
Mailing Address - Fax:864-269-1639
Practice Address - Street 1:8 MEMORIAL MEDICAL CT
Practice Address - Street 2:STE. 6
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4455
Practice Address - Country:US
Practice Address - Phone:864-295-1031
Practice Address - Fax:864-269-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15432261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty