Healthcare Provider Details

I. General information

NPI: 1942081237
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS UROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S LIBERTY DR
BLOOMINGTON IN
47403-5167
US

IV. Provider business mailing address

1520 S LIBERTY DR
BLOOMINGTON IN
47403-5167
US

V. Phone/Fax

Practice location:
  • Phone: 812-676-4300
  • Fax:
Mailing address:
  • Phone: 812-676-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY SHUMATE
Title or Position: UROLOGY MEDIAL DIRECTOR
Credential: MD
Phone: 812-676-4300