1740360379 NPI number — UROLOGY OF INDIANA, L.L.C.

Table of content: (NPI 1740360379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740360379 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:
1740360379
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:
317-885-1250
Provider Business Mailing Address Fax Number:
317-859-4268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8040 CLEARVISTA PKWY
Provider Second Line Business Practice Location Address:
SUITE # 370
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-4673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-813-1660
Provider Business Practice Location Address Fax Number:
317-813-7667
Provider Enumeration Date:
10/17/2006

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




Copyright © 2007-2025 www.npivalidator.com