Provider Demographics
NPI:1912237074
Name:MIDLANDS UROLOGICAL SPECIALISTS
Entity Type:Organization
Organization Name:MIDLANDS UROLOGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:803-796-9968
Mailing Address - Street 1:139 SUMMERPLACE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3058
Mailing Address - Country:US
Mailing Address - Phone:803-796-9968
Mailing Address - Fax:803-753-9105
Practice Address - Street 1:139 SUMMERPLACE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3058
Practice Address - Country:US
Practice Address - Phone:803-796-9968
Practice Address - Fax:803-753-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty