Provider Demographics
NPI:1750556213
Name:PIEDMONT REGIONAL UROLOGY
Entity type:Organization
Organization Name:PIEDMONT REGIONAL UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-833-9151
Mailing Address - Street 1:300 PLANTATION PLAZA
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325
Mailing Address - Country:US
Mailing Address - Phone:864-833-3888
Mailing Address - Fax:864-833-3988
Practice Address - Street 1:300 PLANTATION PLAZA
Practice Address - Street 2:SUITE F
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-833-3888
Practice Address - Fax:864-833-3988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURENS COUNTY HEALTH CARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty