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General NPI Number Information
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NPI Number | 1760749956
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Entity Type | Organization
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Legal Business Name | FIRST UROLOGY, PSC
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1023 NEW MOODY LN STE 202A
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City | LA GRANGE
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State | KY
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Zip | 40031-9177
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Country | US
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Telephone | 502-897-7172
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Fax | 812-282-4172
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL BLVD
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3769
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Country | US
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Telephone | 812-282-3899
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Fax | 812-282-4172
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL J SHANNON
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Credential |
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Telephone | 812-282-3899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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