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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
1230 HOSPITAL DRIVE, #B, MT. PLEASANT, SC 29464-3251
(843) 884-8045
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
480
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP4434
SC
Enumeration date
10/02/2007
Last updated
04/16/2009
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