Provider Demographics
NPI:1447298906
Name:LOW COUNTRY UROLOGY, P.A.
Entity type:Organization
Organization Name:LOW COUNTRY UROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:O'KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-661-0402
Mailing Address - Street 1:1580 FREEDOM BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6074
Mailing Address - Country:US
Mailing Address - Phone:843-661-0402
Mailing Address - Fax:843-661-0960
Practice Address - Street 1:1580 FREEDOM BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6074
Practice Address - Country:US
Practice Address - Phone:843-661-0402
Practice Address - Fax:843-661-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC163156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1485Medicaid
SC$$$$$$$$$OtherSOCIAL SECURITY NUMBER
SC163156OtherSC LICENSE NUMBER
SCF56120Medicare UPIN
SCGP1485Medicaid