NPIMap

Organization Active NPI

Urology Clinic at Carolinas

  • Urology Physician
  • Florence, SC
National Provider Identifier
1790131522
Registry record updated May 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
5395 Issued in SC
Legal business name
UROLOGY CLINIC AT CAROLINAS
Practice address
1594 Freedom Blvd Ste 203
Florence, SC 29505-6046
Phone
(843) 674-1670
Fax
(843) 674-4707
NPI assigned
May 11, 2016
Last updated
May 11, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL ALLIANCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 11, 2016

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

Authorized official

Name
Mr. Larry D Rabon, M.D.
Title
Physician
Phone
(843) 674-1670

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 5395 SC Primary

Addresses

Primary practice location

1594 Freedom Blvd Ste 203
Florence, SC 29505-6046

Mailing address

1594 Freedom Blvd Ste 203
Florence, SC 29505-6046
Phone (843) 674-1670

Other identifiers 1

IdentifierTypeStateIssuer
053952MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Carolinas Medical Alliance Inc3 organizations share this tax ID, including this one
Part of
Carolinas Medical Alliance Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462924800000",
    "number": "1790131522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1594 FREEDOM BLVD STE 203",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056046",
            "telephone_number": "843-674-1670",
            "fax_number": "843-674-4707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1594 FREEDOM BLVD STE 203",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056046",
            "telephone_number": "843-674-1670",
            "fax_number": "843-674-4707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY CLINIC AT CAROLINAS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL ALLIANCE",
        "enumeration_date": "2016-05-11",
        "last_updated": "2016-05-11",
        "status": "A",
        "authorized_official_last_name": "RABON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "843-674-1670",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "5395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053952",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2016; 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.