Provider Demographics
NPI:1578961314
Name:UROLOGY OF INDIANA L.L. C.
Entity Type:Organization
Organization Name:UROLOGY OF INDIANA L.L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-859-7222
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-859-7222
Mailing Address - Fax:317-859-7220
Practice Address - Street 1:120 AVON MARKET PL STE 200
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6021
Practice Address - Country:US
Practice Address - Phone:317-671-8032
Practice Address - Fax:317-671-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194370 UMedicaid
IN1578961314OtherNSC NPI #
IN1487680518OtherGROUP NPI
IN1578961314OtherNSC NPI #
IN100194370 UMedicaid