Provider Demographics
NPI:1023021805
Name:THE UROLOGY GROUP
Entity type:Organization
Organization Name:THE UROLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-208-3100
Mailing Address - Street 1:300 NEW RIVER PKWY STE 17
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4549
Mailing Address - Country:US
Mailing Address - Phone:843-208-3100
Mailing Address - Fax:877-649-6028
Practice Address - Street 1:300 NEW RIVER PKWY STE 17
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4549
Practice Address - Country:US
Practice Address - Phone:843-208-3100
Practice Address - Fax:877-649-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2982Medicaid
SCGP2982Medicaid
SC5251480001Medicare NSC