Provider Demographics
NPI:1912368457
Name:UROLOGY CLINIC, INC.
Entity Type:Organization
Organization Name:UROLOGY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-464-5161
Mailing Address - Street 1:1285 WILSON HALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1804
Mailing Address - Country:US
Mailing Address - Phone:803-905-3555
Mailing Address - Fax:803-905-3570
Practice Address - Street 1:1285 WILSON HALL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-905-3555
Practice Address - Fax:803-905-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27784208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1912368457OtherBCBS OF SC
SCGP7304Medicaid