Provider Demographics
NPI:1619063641
Name:LOUISVILLE UROLOGY
Entity Type:Organization
Organization Name:LOUISVILLE UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:UHLENHUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-375-0009
Mailing Address - Street 1:1900 BLUEGRASS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215
Mailing Address - Country:US
Mailing Address - Phone:502-375-0009
Mailing Address - Fax:502-375-2150
Practice Address - Street 1:1900 BLUEGRASS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215
Practice Address - Country:US
Practice Address - Phone:502-375-0009
Practice Address - Fax:502-375-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
340019489OtherRAILROAD MEDI CARE
KY1106100OtherPASSPORT
KY65909285Medicaid
KY65909285Medicaid
KY6153Medicare ID - Type Unspecified
KY6154Medicare ID - Type Unspecified