Healthcare Provider Details

I. General information

NPI: 1992922025
Provider Name (Legal Business Name): SPRINGFIELD UROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 E HOME RD
SPRINGFIELD OH
45503-2726
US

IV. Provider business mailing address

1164 E HOME RD SUITE J
SPRINGFIELD OH
45503-2726
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-9260
  • Fax: 937-342-9262
Mailing address:
  • Phone: 937-342-9260
  • Fax: 937-342-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINA KAY STUART
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-342-9260