1821355686 NPI number — FIRST UROLOGY, PSC

Table of content: (NPI 1821355686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821355686 NPI number — FIRST UROLOGY, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST UROLOGY, PSC
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:
SOUTHERN INDIANA RADIATION THERAPY CENTER
Provider Other Organization Name Type Code:
3
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:
1821355686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HOSPITAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-282-3899
Provider Business Mailing Address Fax Number:
812-282-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1322 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-285-6000
Provider Business Practice Location Address Fax Number:
812-285-6010
Provider Enumeration Date:
04/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SHANNON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
812-282-3899

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 78902830 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65906414 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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