1013001452 NPI number — UROLOGY ASSOCIATES OF SOUTHERN INDIANA, P.C.

Table of content: (NPI 1013001452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013001452 NPI number — UROLOGY ASSOCIATES OF SOUTHERN INDIANA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY ASSOCIATES OF SOUTHERN INDIANA, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013001452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-375-1550
Provider Business Mailing Address Fax Number:
812-375-1581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-375-1550
Provider Business Practice Location Address Fax Number:
812-375-1581
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-375-1550

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  0039854 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 01039609A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200406560A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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