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Organization
PALMETTO ADULT AND CHILDRENS UROLOGY PA
Active
Organization
PALMETTO ADULT AND CHILDRENS UROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMELIA MUNKBERG (PRACTICE ADMINISTRATOR)
(843) 797-6600
Entity
Organization
Contact information
Practice address
2890 TRICOM ST, NORTH CHARLESTON, SC 29406-9171
(843) 797-6600
(843) 820-1440
Mailing address
2890 TRICOM ST, NORTH CHARLESTON, SC 29406-9171
(843) 797-6600
(843) 820-1440
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7026
MEDICARE GROUP NUMBER
SC
05
—
GP4871
—
SC
Enumeration date
10/11/2005
Last updated
04/20/2021
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