Provider Demographics
NPI:1619171030
Name:LANDMARK UROLOGY PSC
Entity Type:Organization
Organization Name:LANDMARK UROLOGY PSC
Other - Org Name:AMBERLY K. WINDISCH, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WINDISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-868-9748
Mailing Address - Street 1:103 S BRADFORD LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2336
Mailing Address - Country:US
Mailing Address - Phone:502-868-9748
Mailing Address - Fax:502-868-9749
Practice Address - Street 1:103 S BRADFORD LN
Practice Address - Street 2:SUITE 101
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2336
Practice Address - Country:US
Practice Address - Phone:502-868-9748
Practice Address - Fax:502-868-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41104208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801090220OtherNPI INDIVIDUAL
KY7100018160Medicaid
1801090220OtherNPI INDIVIDUAL
KY000275001Medicare PIN