MEDICARE: SOUTHWESTERN OHIO UROLOGY INC

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	OH34005879	OH

General Provider Information

NPI Number	:	1538346929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWESTERN OHIO UROLOGY INC

Provider Business Mailing Address
First Line	:	1150 W LOCUST ST
Second Line	:	SUITE 600
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2572
Country	:	US
Telephone Number	:	937-382-1141
Fax Number	:	937-383-2630

Provider Business Practice Location Address
First Line	:	1150 W LOCUST ST
Second Line	:	SUITE 600
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2572
Country	:	US
Telephone Number	:	937-382-1141
Fax Number	:	937-383-2630

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. CHRISTOPHER DONALD LAWLEY
Credential	:	D.O.
Telephone Number	:	937-382-1141

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/29/2008

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