MEDICARE: FIRST UROLOGY, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208800000X	Urology Physician
2	363L00000X	Nurse Practitioner
3	2085R0202X	Diagnostic Radiology Physician
4	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1790539708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST UROLOGY, PSC

Provider Business Mailing Address
First Line	:	101 HOSPITAL BLVD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3769
Country	:	US
Telephone Number	:	812-282-3899
Fax Number	:	812-282-4172

Provider Business Practice Location Address
First Line	:	3906 S DUPONT SQ
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4647
Country	:	US
Telephone Number	:	812-282-3899
Fax Number	:	812-282-4172

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL SHANNON
Credential	:
Telephone Number	:	812-282-3899

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	03/11/2026

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