Organization
LOWCOUNTRY UROLOGY CLINICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE S HADER (APPOINTED OFFICIAL)
(843) 284-4267
Entity
Organization
Contact information
Practice address
125 DOUGHTY ST, #380, CHARLESTON, SC 29403-9140
(843) 577-9530
Mailing address
2687 LAKE PARK DRIVE, N. CHARLESTON, SC 29406-9100
(843) 725-4414
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
34646
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP44237
—
SC
Enumeration date
10/02/2007
Last updated
04/16/2009
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