NPIMap

Organization Active NPI

Carolina Urology Center, PA

  • Urology Physician
  • Fort Mill, SC
National Provider Identifier
1952561623
Registry record updated Dec 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
CAROLINA UROLOGY CENTER, PA
Practice address
580 Kingsley Park Dr
Suite 150
Fort Mill, SC 29715-6403
Phone
(803) 578-7600
Fax
(803) 431-2257
NPI assigned
Jun 16, 2008
Last updated
Dec 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2008

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

Authorized official

Name
Tracy Black
Title
Administrator
Phone
(803) 327-1116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

580 Kingsley Park Dr
Suite 150
Fort Mill, SC 29715-6403

Mailing address

1780 Medical Park Dr
Rock Hill, SC 29732-1194
Phone (803) 327-1116

Other identifiers 1

IdentifierTypeStateIssuer
PA4307MedicaidSC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1952561623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1780 MEDICAL PARK DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321194",
            "telephone_number": "803-327-1116",
            "fax_number": "803-327-6872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 KINGSLEY PARK DR",
            "address_2": "SUITE 150",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297156403",
            "telephone_number": "803-578-7600",
            "fax_number": "803-431-2257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA UROLOGY CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-327-1116"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA4307",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.