PALMETTO ADULT AND CHILDRENS UROLOGY PA - NPI 1467440644

Q: What is Palmetto Adult And Childrens Urology PA's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

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About Palmetto Adult And Childrens Urology Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PALMETTO ADULT AND CHILDRENS UROLOGY PA (NPI 1467440644) is a healthcare organization registered as an urology in North Charleston, South Carolina and active in the NPI registry since October 2005. The organization holds a CLIA Waiver certificate valid through November 11, 2027, maintains 3 additional practice locations, and lists Amelia Munkberg, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1467440644

Entity TypeOrganization

Primary Taxonomy208800000X

Legal Business NamePALMETTO ADULT AND CHILDRENS UROLOGY PA

Location Address2890 TRICOM STNorth Charleston, SC 29406-9171

Mailing Address2890 Tricom StNorth Charleston, SC 29406-9171 · (843) 797-6600 · Fax (843) 820-1440

Phone(843) 797-6600

Fax(843) 820-1440

Organization SubpartNo

Authorized OfficialAmelia MunkbergPractice Administrator · (843) 797-6600

Enumeration DateOctober 11, 2005

Last NPPES UpdateApril 20, 2021

NPPES CertifiedApril 20, 2021

✔ NPI 1467440644 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians

Taxonomy Code208800000X

Definition

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.

2890 TRICOM ST, North Charleston, SC 29406

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Secondary Practice Locations 3

Location 1104 Morgan Pl Ste CSummerville, SC 29485-8106 · Phone (843) 797-6600 · Fax (843) 820-1440

Location 25500 Front St Ste 250Summerville, SC 29486-8140 · Phone (843) 797-6600 · Fax (843) 820-1440

Location 3302 Medical Park Dr Ste 207Walterboro, SC 29488-5749 · Phone (843) 797-6600 · Fax (843) 820-1440

Other Identifiers 2

Other7026SC · Medicare Group Number

MedicaidGP4871SC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 42D2104778

Palmetto Adult And Childrens Urology · Summerville, SC

Active · expires Nov 11, 2027

CLIA Number42D2104778

Laboratory TypePhysician Office

Certificate Effective DateNovember 12, 2025

Certificate Expiration DateNovember 11, 2027

Laboratory DirectorTheodore E. Brisson

Laboratory Phone(843) 797-7660

Laboratory LocationPalmetto Adult And Childrens Urology104 C Morgan Place, Summerville, SC 29485

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. GRACE ELIZABETH HOWIE PA

Physician Assistant