Provider Demographics
NPI:1104183375
Name:FIRST UROLOGY, PSC
Entity Type:Organization
Organization Name:FIRST UROLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-282-3899
Mailing Address - Street 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3769
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4172
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-941-0443
Practice Address - Fax:812-282-4172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST UROLOGY, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-12
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN122620OtherIN MEDICARE
KY78902830Medicaid
KY65906414Medicaid
IN100075260Medicaid