=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467642983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROLOGY SPECIALISTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 07/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1912 EAST NATIONAL HIGHWAY
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-882-4320
-----------------------------------------------------
Fax | 812-882-2706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SOUTH SIXTH STREET
-----------------------------------------------------
City | VINCENNES
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-882-4320
-----------------------------------------------------
Fax | 812-882-2706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM R VAUGHN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 812-882-4320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 50002969A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------