Provider Demographics
NPI:1619035409
Name:ALLIED UROLOGY, P.S.C.
Entity Type:Organization
Organization Name:ALLIED UROLOGY, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:H
Authorized Official - Last Name:WITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-5147
Mailing Address - Street 1:912 DUPONT ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4602
Mailing Address - Country:US
Mailing Address - Phone:502-897-5147
Mailing Address - Fax:502-895-3783
Practice Address - Street 1:912 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4602
Practice Address - Country:US
Practice Address - Phone:502-897-5147
Practice Address - Fax:502-895-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200821820AOtherMEDICAID IN
KY65945222Medicaid
KYDE6177OtherRAILROAD MEDICARE
IN234570Medicare PIN
KYDE6177OtherRAILROAD MEDICARE