NPIMap

Organization Active NPI

Southern Kentucky Urology LLC

  • Urology Physician
  • Bowling Green, KY
National Provider Identifier
1114962867
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
01046326A Issued in IN
Legal business name
SOUTHERN KENTUCKY UROLOGY LLC
Practice address
1325 Andrea St
Suite 103
Bowling Green, KY 42104-5852
Phone
(270) 796-9191
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chuck Locke
Title
Vice President
Phone
(615) 373-7604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208800000X 01046326A IN Primary

Addresses

Primary practice location

1325 Andrea St
Suite 103
Bowling Green, KY 42104-5852

Mailing address

1325 Andrea St
Suite 103
Bowling Green, KY 42104-5852
Phone (270) 796-9191

Other identifiers 1

IdentifierTypeStateIssuer
7100003160MedicaidKY

Other names 1

  • Southern Kentucky Urology Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1114962867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 ANDREA ST",
            "address_2": "SUITE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421045852",
            "telephone_number": "270-796-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 ANDREA ST",
            "address_2": "SUITE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421045852",
            "telephone_number": "270-796-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN KENTUCKY UROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LOCKE",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-373-7604"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology",
            "state": "IN",
            "license": "01046326A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100003160",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Kentucky Urology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.