# CAROLINA UROLOGY CENTER, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336164227
- **Authorized official:** TRACY BLACK (PRACTICE MANAGER)
- **Authorized official phone:** (803) 327-1116

## Contact information

- **Practice address:** 1077 W MEETING ST, SUITE A, LANCASTER, SC 29720-2205
- **Practice address phone:** (803) 285-1337
- **Practice address fax:** (803) 285-4772
- **Mailing address:** 1780 MEDICAL PARK DR, ROCK HILL, SC 29732-1194
- **Mailing address phone:** (803) 327-1116
- **Mailing address fax:** (803) 327-6872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2006
- **Last updated:** 10/09/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8902555 | — | NC |
| 05 | — | PA4307 | — | SC |