FIRST UROLOGY, PSC

Provider Demographics

• NPI: 1922099811
• Name: FIRST UROLOGY, PSC
• Entity Type: Organization
• Organization Name: FIRST UROLOGY, PSC
• Other - Org Name: DBA SOUTHERN INDIANA RADIATIONTHERAPY CENTER
• Other - Org Type: Other Name
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: MICHEAL
• Authorized Official - Last Name: SHANNON
• Authorized Official - Phone: 812-282-3899
• Mailing Address - Street 1: 101 HOSPITAL BLVD
• Mailing Address - City: JEFFERSONVILLE
• Mailing Address - State: IN
• Mailing Address - Zip Code: 47130-3769
• Mailing Address - Country: US
• Mailing Address - Phone: 812-282-3899
• Mailing Address - Fax: 812-282-4172
• Practice Address - Street 1: 101 HOSPITAL BLVD
• Practice Address - City: JEFFERSONVILLE
• Practice Address - State: IN
• Practice Address - Zip Code: 47130-3769
• Practice Address - Country: US
• Practice Address - Phone: 812-282-3899
• Practice Address - Fax: 812-282-4172
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: FIRST UROLOGY,PSC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2005-10-31
• Last Update Date: 2023-10-17

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208800000X	Allopathic & Osteopathic Physicians	Urology		Group - Multi-Specialty
No	207ZP0102X	Allopathic & Osteopathic Physicians	Pathology	Anatomic Pathology & Clinical Pathology	Group - Multi-Specialty
No	2085R0001X	Allopathic & Osteopathic Physicians	Radiology	Radiation Oncology	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	CG9483	Other	RR MEDCIARE
KY	CF7705	Other	RR MEDICARE
IN	100075260	Medicaid
KY	65906414	Medicaid
KY	78902830	Medicaid
KY	0453090001	Medicare NSC
IN	100075260	Medicaid
IN	0453090002	Medicare NSC
IN	122620	Medicare PIN