Provider Demographics
NPI:1326093147
Name:UROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SAMPSON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-289-7444
Mailing Address - Street 1:2525 W UNIVERSITY AVE SUITE 504
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3409
Mailing Address - Country:US
Mailing Address - Phone:765-289-7444
Mailing Address - Fax:765-289-8628
Practice Address - Street 1:2525 W UNIVERSITY AVE SUITE 504
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3409
Practice Address - Country:US
Practice Address - Phone:765-289-7444
Practice Address - Fax:765-289-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200066660 AMedicaid
IN200066660Medicaid
IN200066660 AMedicaid
1260720001Medicare NSC