Provider Demographics
NPI:1316126451
Name:AIKEN UROLOGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:AIKEN UROLOGICAL ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VON BUEDINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-648-7815
Mailing Address - Street 1:191 CENTRE SOUTH BLVD
Mailing Address - Street 2:STE#20
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6313
Mailing Address - Country:US
Mailing Address - Phone:803-648-7815
Mailing Address - Fax:803-648-8028
Practice Address - Street 1:191 CENTRE SOUTH BLVD
Practice Address - Street 2:STE#20
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6313
Practice Address - Country:US
Practice Address - Phone:803-648-7815
Practice Address - Fax:803-648-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5580208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0999Medicaid
340013053OtherRAILROAD MEDICARE
SCE01226Medicare UPIN
SC3497Medicare PIN