MEDICARE: SOUTHWEST UROLOGY, LLC

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1659068930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST UROLOGY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 931936
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-1936
Country	:	US
Telephone Number	:	888-802-9885
Fax Number	:	615-783-1082

Provider Business Practice Location Address
First Line	:	18099 LORAIN AVE STE 141
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-4411
Country	:	US
Telephone Number	:	216-941-0333
Fax Number	:	216-941-5257

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT & CFO
Name	:	CHAOQIANG LIN
Credential	:
Telephone Number	:	214-587-4079

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	02/19/2026

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