Organization Active NPI

Foothills Urology

  • Specialist
  • Easley, SC
National Provider Identifier
1376715797
Registry record updated Mar 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
7514 Issued in SC
Legal business name
FOOTHILLS UROLOGY
Practice address
403 Hillcrest Dr
Suite a
Easley, SC 29640-1207
Phone
(864) 855-6811
Fax
(864) 855-6784
NPI assigned
Mar 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Mary K Nickles, MBA
Title
Office Manager
Phone
(864) 855-6811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 7514 SC Primary

Addresses

Primary practice location

403 Hillcrest Dr
Suite a
Easley, SC 29640-1207

Mailing address

PO Box 1793
Easley, SC 29641-1793
Phone (864) 855-6811

Other identifiers 1

IdentifierTypeStateIssuer
GP0270MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206489600000",
    "number": "1376715797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1793",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296411793",
            "telephone_number": "864-855-6811",
            "fax_number": "864-855-6784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 HILLCREST DR",
            "address_2": "SUITE A",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296401207",
            "telephone_number": "864-855-6811",
            "fax_number": "864-855-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS UROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-26",
        "last_updated": "2008-03-26",
        "status": "A",
        "authorized_official_last_name": "NICKLES",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "864-855-6811",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "7514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0270",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Easley, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.