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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
1780 MEDICAL PARK DR, ROCK HILL, SC 29732-1194
(803) 327-1116
(803) 327-6872
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
02555
BCBS
NC
05
PA4307
SC
Enumeration date
07/13/2006
Last updated
10/09/2007
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