Provider Demographics
NPI:1821496662
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 1:2451 INTELLIPLEX DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8580
Practice Address - Country:US
Practice Address - Phone:317-398-5303
Practice Address - Fax:317-398-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1487680518OtherGROUP NPI
IN100194370 QMedicaid
IN677730Medicare PIN