1619035409 NPI number — ALLIED UROLOGY, P.S.C.

Table of content: (NPI 1619035409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619035409 NPI number — ALLIED UROLOGY, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIED UROLOGY, P.S.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:
1619035409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 DUPONT ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-897-5147
Provider Business Mailing Address Fax Number:
502-895-3783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 DUPONT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-5147
Provider Business Practice Location Address Fax Number:
502-895-3783
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WITTEN
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
502-897-5147

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200821820A . This is a "MEDICAID IN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 65945222 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE6177 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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