Provider Demographics
NPI:1528153731
Name:UROLOGIC SURGERY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:UROLOGIC SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:864-716-6100
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE 2900
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-716-6100
Mailing Address - Fax:864-716-6120
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 2900
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-716-6100
Practice Address - Fax:864-716-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2231Medicaid
SCGP2231Medicaid