MEDICARE: UROLOGY SPECIALISTS, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	50002969A	IN

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	:	1366597775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY SPECIALISTS, P.C.

Provider Business Mailing Address
First Line	:	200 SOUTH SIXTH STREET
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591
Country	:	US
Telephone Number	:	812-882-4320
Fax Number	:	812-882-2706

Provider Business Practice Location Address
First Line	:	105 N 2ND AVE
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-1005
Country	:	US
Telephone Number	:	812-385-5820
Fax Number	:	812-882-2706

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM R VAUGHN
Credential	:	M.D.
Telephone Number	:	812-882-4320

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/07/2009

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