Healthcare Provider Details

I. General information

NPI: 1477542017
Provider Name (Legal Business Name): UROLOGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S HEBRON AVE
EVANSVILLE IN
47714-4086
US

IV. Provider business mailing address

PO BOX 5106
EVANSVILLE IN
47716-5106
US

V. Phone/Fax

Practice location:
  • Phone: 812-473-1111
  • Fax: 812-473-0911
Mailing address:
  • Phone: 812-473-1111
  • Fax: 812-473-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: BILL J SAMM
Title or Position: PRESIDENT
Credential: MD
Phone: 812-473-1111