COASTAL CAROLINA UROLOGY GROUP LLC (NPI# 1477612703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477612703 |
| Entity Type | Organization |
| Organization Name | COASTAL CAROLINA UROLOGY GROUP LLC |
| Practice Address |
1055 Ribaut Rd Suite 10 Beaufort SC 29902-5423 |
| Mailing Address |
Po Box 440007 Nashville TN 37244-0007 |
| Practice Telephone | 8435247607 |
| Practice Fax Number | 8435246737 |
| Mailing Telephone | 8884824871 |
| Mailing Fax Number | 6152616052 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2010-01-14 |
| Authorized Official Name | JEANINE SAWLER (PRACTICE MANAGER) |
| Authorized Official Telephone | 8435247607 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MCRR PIN | CG7000 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124161682 | Coastal Carolina Urology Group LLC | Urology | 1010 Medical Center Dr, Suite 100, Hardeeville, SC 29927-3447 | 2007-02-15 |
| Street Address |
1055 RIBAUT RD SUITE 10 |
| City | BEAUFORT |
| State | SC |
| Zip Code | 29902-5423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750385274 | Internal Medicine Healthcare, P.a. | Internal Medicine | 1055 Ribaut Rd, Ste 10, Beaufort, SC 29902-3402 | 2005-06-13 |
| 1962948679 | Cameron Paige Price | Physician Assistant | 1055 Ribaut Rd, Suite 30, Beaufort, SC 29902-5423 | 2017-01-19 |
| 1972906626 | Nancy Elizabeth Thomas | Physician Assistant | 1055 Ribaut Rd, Beaufort, SC 29902-5423 | 2014-10-08 |
| 1528101664 | Coastal Carolina Urology Group, LLC | Urology | 1055 Ribaut Rd, Suite 10, Beaufort, SC 29902-5423 | 2007-02-15 |
| 1659446219 | Primecare Health Center Pa | Specialist | 1055 Ribaut Rd, Suite 10, Beaufort, SC 29902-5423 | 2006-11-21 |
| 1013081678 | John B Adams II | Urology | 1055 Ribaut Rd, Suite 10, Beaufort, SC 29902-5423 | 2006-11-17 |
| 1881768430 | Louis F Plzak IIi | Urology | 1055 Ribaut Rd, Suite 10, Beaufort, SC 29902-5423 | 2006-11-17 |
| 1821062423 | Gordon E Krueger | Surgery | 1055 Ribaut Rd, Ste 30, Beaufort, SC 29902-5447 | 2006-02-13 |
| 1538132931 | James Chadwick Tober | Surgery | 1055 Ribaut Rd, Ste 30, Beaufort, SC 29902-5447 | 2006-02-08 |
| 1811960214 | Ronald S Wise | Surgery | 1055 Ribaut Rd, Ste 30, Beaufort, SC 29902-5447 | 2006-02-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063024578 | Beaufort County Memorial Hospital | Family Medicine | Beaufort Memorial Preoperative Assessment Clinic, 989 Ribaut Road Suite 370, Beaufort, SC 29902 | 2020-08-18 |
| 1750992475 | Fayth Polite | Social Worker | 2210 Salem Drive East, Beaufort, SC 29902 | 2020-08-14 |
| 1417509530 | Andrew Grant Miner | Dentist | Naval Hospital Beaufort, 1 Pinckney Blvd., Fpo, AA 29902 | 2019-07-09 |
| 1376029777 | Edward Dela Fuente | Counselor | Coastal Empire Mental Health Center, 1050 Ribaut Road, Beaufort, SC 29902 | 2018-07-18 |
| 1114440419 | Kristin Webb | Registered Nurse | 607 Wilmington Street, Beaufort, SC 29902 | 2017-07-19 |
| 1326582081 | Annemarie Gierling Gault | Nurse Practitioner | Beaufort Memorial Medical Oncology Infusion Center, 989 Ribaut Rd, Ste 103, Beaufort, SC 29902 | 2016-12-14 |
| 1114396579 | Jacquelyn Faith Proulx | Dentist | 1 Pickney Blvd., Naval Hospital Beaufort, Beaufort, SC 29902 | 2015-09-16 |
| 1386028413 | Howard Family Dental - Beaufort, Pllc | Dentist | 35 Robert Smalls Pkwy, Beaufort, SC 29902 | 2015-07-18 |
| 1598018103 | Lisa Marie Johnson | Occupational Therapist | 9555 Ribaut Road, Beaufort Memorial Hospital, Beaufort, SC 29902 | 2012-10-19 |
| 1134497860 | Jeremy Michael Simmons | Pharmacist | 2127 Boundary Street, Suite 19, Beaufort, SC 29902 | 2011-12-08 |
| Find all providers in zip 29902 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528101664 | Coastal Carolina Urology Group, LLC | Urology | 1055 Ribaut Rd, Suite 10, Beaufort, SC 29902-5423 | 2007-02-15 |
| 1013081678 | John B Adams II | Urology | 1055 Ribaut Rd, Suite 10, Beaufort, SC 29902-5423 | 2006-11-17 |
| 1881768430 | Louis F Plzak IIi | Urology | 1055 Ribaut Rd, Suite 10, Beaufort, SC 29902-5423 | 2006-11-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295393098 | Christopher William Ritchie | Urology | 135 Rutledge Ave Fl 5, Charleston, SC 29425-8903 | 2019-06-05 |
| 1780248211 | Spartanburg Medical Center | Urology | 2755 S Highway 14 Ste 2050a, Greer, SC 29650-4902 | 2019-04-30 |
| 1609345982 | Spartanburg Medical Center | Urology | 1552 N Limestone St Ste A, Gaffney, SC 29340-4750 | 2018-11-16 |
| 1942775952 | Roper Saint Francis Physicians Network | Urology | 300 Callen Blvd Ste 220, Summerville, SC 29486-2809 | 2018-10-05 |
| 1790131522 | Urology Clinic At Carolinas | Urology | 1594 Freedom Blvd Ste 203, Florence, SC 29505-6046 | 2016-05-11 |
| 1912368457 | Urology Clinic, Inc. | Urology | 1285 Wilson Hall Rd, Sumter, SC 29150 | 2016-03-11 |
| 1154700367 | Gregory Slachta | Urology | 407 Broadview Dr, Ridgeland, SC 29936-5157 | 2015-05-20 |
| 1467893404 | Robert Strehlow Vi | Urology | 391 Serpentine Dr Ste 500, Spartanburg, SC 29303-3083 | 2013-07-06 |
| 1326487588 | Tracy Jon Tipton | Urology | 125 Doughty St Ste 300, Charleston, SC 29403 | 2013-06-21 |
| 1790121424 | Philip Andre Fontenot Jr. | Urology | 50 Bear Dr, Greenville, SC 29605 | 2013-05-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.