Basic Information
| Provider Information | |||||||||
| NPI: | 1669437083 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPSTATE UROLOGY AND ASSOCIATES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 MEMORIAL MEDICAL CT | ||||||||
| Address2: | STE. 6 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642951031 | ||||||||
| FaxNumber: | 8642691639 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 MEMORIAL MEDICAL CT | ||||||||
| Address2: | STE. 6 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642951031 | ||||||||
| FaxNumber: | 8642691639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 03/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | FLANAGAN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8642951031 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 15432 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.