Healthcare Provider Details

I. General information

NPI: 1891052007
Provider Name (Legal Business Name): FIRST UROLOGY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 AUDUBON PLAZA DR SUITE L10
LOUISVILLE KY
40217-1300
US

IV. Provider business mailing address

101 HOSPITAL BLVD
JEFFERSONVILLE IN
47130-3769
US

V. Phone/Fax

Practice location:
  • Phone: 502-634-1418
  • Fax: 812-282-4172
Mailing address:
  • Phone: 812-282-3899
  • Fax: 812-282-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J SHANNON
Title or Position: CEO
Credential:
Phone: 812-282-3899