Provider Demographics
NPI:1942081237
Name:INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS UROLOGY
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGY MEDIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUMATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-676-4300
Mailing Address - Street 1:1520 S LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5167
Mailing Address - Country:US
Mailing Address - Phone:812-676-4300
Mailing Address - Fax:
Practice Address - Street 1:1520 S LIBERTY DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5167
Practice Address - Country:US
Practice Address - Phone:812-676-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty