Basic Information
| Provider Information | |||||||||
| NPI: | 1831445212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA UROLOGY PARTNERS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9735 KINCEY AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280789118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044142870 | ||||||||
| FaxNumber: | 7044142864 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 SUMMERPLACE DR | ||||||||
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| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037969968 | ||||||||
| FaxNumber: | 8037910376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2012 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROCHE | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO / COO | ||||||||
| AuthorizedOfficialTelephone: | 7044142852 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.