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General NPI Number Information
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NPI Number | 1205916830
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Entity Type | Organization
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Legal Business Name | UROLOGY OF INDIANA, L.L.C.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 679 E COUNTY LINE RD
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City | GREENWOOD
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State | IN
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Zip | 46143-1049
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Country | US
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Telephone | 317-885-1250
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Fax | 317-859-4269
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Provider Business Mailing Address
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Address Line | 679 E COUNTY LINE RD
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City | GREENWOOD
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State | IN
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Zip | 46143-1049
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Country | US
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Telephone | 317-885-1250
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Fax | 317-859-4268
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Authorized Official
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Title or Position | M.D./ OWNER
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Name | DR. BRADLEY G ORRIS
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Credential | M.D.
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Telephone | 317-859-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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