Organization
COASTAL CAROLINA UROLOGY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY SUE HOWE (BILLING SUPERVISOR)
(888) 482-4871
Entity
Organization
Contact information
Practice address
1055 RIBAUT RD, SUITE 10, BEAUFORT, SC 29902-5423
(843) 524-7607
(843) 524-6737
Mailing address
PO BOX 440007, NASHVILLE, TN 37244-0007
(888) 482-4871
(615) 261-6052
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
200011
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG7000
RR MEDICARE
SC
Enumeration date
02/15/2007
Last updated
03/31/2015
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