MEDICARE: UROLOGY OF INDIANA, L.L.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	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1487680518	OTHER	IN	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548340177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY OF INDIANA, L.L.C.

Provider Business Mailing Address
First Line	:	679 E COUNTY LINE RD
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1049
Country	:	US
Telephone Number	:	317-885-1250
Fax Number	:	317-859-4268

Provider Business Practice Location Address
First Line	:	8240 NAAB RD STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1986
Country	:	US
Telephone Number	:	317-876-2330
Fax Number	:	317-876-2320

Authorized Official
Title or Position	:	M.D. /OWNER
Name	:	DR. BRADLEY G. ORRIS
Credential	:	M.D.
Telephone Number	:	317-859-7222

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/17/2021

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