1487052221 NPI number — UROLOGY OF INDIANA L.L.C.

Table of content: (NPI 1487052221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487052221 NPI number — UROLOGY OF INDIANA L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY OF INDIANA L.L.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:
1487052221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
679 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46143-1049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-859-7222
Provider Business Mailing Address Fax Number:
317-859-7220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 HADLEY RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46158-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-831-3043
Provider Business Practice Location Address Fax Number:
317-831-3089
Provider Enumeration Date:
12/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ORRIS
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
M.D./OWNER
Authorized Official Telephone Number:
317-859-7222

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100194370 T , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1487680518 . This is a "GROUP NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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