Provider Demographics
NPI:1023217015
Name:STOKES INSTITUTE OF UROLOGY, LLC
Entity Type:Organization
Organization Name:STOKES INSTITUTE OF UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:618-351-9300
Mailing Address - Street 1:305 W JACKSON ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1474
Mailing Address - Country:US
Mailing Address - Phone:618-351-9300
Mailing Address - Fax:618-351-9307
Practice Address - Street 1:305 W JACKSON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-351-9300
Practice Address - Fax:618-351-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089297174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03932016OtherBCBS OF ILLINOIS
ILP00070868OtherRAILROAD MEDICARE PIN
IL036089297Medicaid
ILDA7587OtherRAILROAD MEDICARE GROUP
ILP00152699OtherRAILROAD MEDICARE PIN
ILG80608OtherUPIN #
IL632586OtherHEALTHLINK
IL090870OtherHEALTH ALLIANCE
ILR78376OtherUPIN #
ILP00070868OtherRAILROAD MEDICARE PIN
IL208107Medicare PIN
ILK03797Medicare PIN
ILG80608OtherUPIN #
ILG80608Medicare UPIN
IL036089297Medicaid
IL209026Medicare PIN
ILP00152699OtherRAILROAD MEDICARE PIN