Provider Demographics
NPI:1245270198
Name:FLORENCE UROLOGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:FLORENCE UROLOGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-662-3423
Mailing Address - Street 1:214 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4725
Mailing Address - Country:US
Mailing Address - Phone:843-662-3423
Mailing Address - Fax:843-667-6842
Practice Address - Street 1:214 W PINE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4725
Practice Address - Country:US
Practice Address - Phone:843-662-3423
Practice Address - Fax:843-667-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA306Medicaid
SCPA306Medicaid