Healthcare Provider Details

I. General information

NPI: 1780454017
Provider Name (Legal Business Name): AUC UROLOGISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PROFESSIONAL PARK DR
CONWAY SC
29526-9261
US

IV. Provider business mailing address

611 BURROUGHS AND CHAPIN BLVD STE 105
MYRTLE BEACH SC
29577-3200
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-2450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TIMOTHY J QUILLEN
Title or Position: PHYSICIAN
Credential: MD
Phone: 914-815-1382