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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

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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