MEDICARE: FIRST UROLOGY, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	2085R0001X	Radiation Oncology Physician
3	2085R0202X	Diagnostic Radiology Physician
4	208800000X	Urology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104183953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST UROLOGY, PSC

Provider Business Mailing Address
First Line	:	101 HOSPITAL BLVD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3769
Country	:	US
Telephone Number	:	812-282-3899
Fax Number	:	812-282-4172

Provider Business Practice Location Address
First Line	:	3920 S DUPONT SQ STE C
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4615
Country	:	US
Telephone Number	:	502-721-0116
Fax Number	:	812-282-4172

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL J SHANNON
Credential	:
Telephone Number	:	812-282-3899

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	03/11/2026

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Directions to “FIRST UROLOGY, PSC ” Practice Location

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