MEDICARE: FIRST UROLOGY, PSC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy
1	363LA2100X	Acute Care Nurse Practitioner
2	363LA2200X	Adult Health Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner
4	363L00000X	Nurse Practitioner
5	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
6	363A00000X	Physician Assistant
7	2085R0204X	Vascular & Interventional Radiology Physician
8	2085R0001X	Radiation Oncology Physician
9	2085R0202X	Diagnostic Radiology Physician
10	208800000X	Urology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF7705	OTHER	KY	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	CG9483	OTHER	IN	RR MEDCIARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1922099811
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	:	101 HOSPITAL BLVD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3769
Country	:	US
Telephone Number	:	812-282-3899
Fax Number	:	812-282-4172

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	03/11/2026