Provider Demographics
NPI:1992898076
Name:CAPITOL UROLOGY, PA
Entity type:Organization
Organization Name:CAPITOL UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:EDMUNDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-251-6602
Mailing Address - Street 1:2724 MIDDLEBURG DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2437
Mailing Address - Country:US
Mailing Address - Phone:803-251-6602
Mailing Address - Fax:803-251-6605
Practice Address - Street 1:2724 MIDDLEBURG DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2437
Practice Address - Country:US
Practice Address - Phone:803-251-6602
Practice Address - Fax:803-251-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4640Medicaid
SCGP4640Medicaid