Organization
CAROLINA UROLOGY CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY BLACK (PRACTICE MANAGER)
(803) 327-1116
Entity
Organization
Contact information
Practice address
10620 PARK RD, SUITE 218, CHARLOTTE, NC 28210-8472
(704) 543-7186
(704) 543-7094
Mailing address
1780 MEDICAL PARK DR, ROCK HILL, SC 29732-1194
(803) 327-1116
(803) 327-6872
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0127V
BCBS
NC
01
—
02555
BC/BS
NC
05
—
890127V
—
NC
Enumeration date
07/13/2006
Last updated
10/09/2007
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