Advanced Urology LLC
Organization Active NPI Specialist · Indianapolis, IN
NPI 1124156336 · NPPES record last updated Jun 24, 2010
Key facts
- NPI
- 1124156336
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 01051162A (IN)
- Legal business name
- ADVANCED UROLOGY LLC
- Practice address
- 8091 Township Line Rd
Suite 109
Indianapolis, IN 46260-2494 - Phone
- (317) 802-9900
- Fax
- (317) 802-9911
- NPI assigned
- Mar 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. James Andrew Dugan, M.D.
- Title
- Ceo
- Phone
- (317) 802-9900
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0996016 | Advanced Urology LLC | Provider-performed microscopy | Apr 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060120000545 | IN | Part B Supplier - Clinic/Group Practice | 3072537760 |
Receives reassigned benefits from 1 practitioner Practice locations: Indianapolis, IN; Kokomo, IN; Peru, IN |
National Provider Directory
Locations
8091 Township Line Rd
Ste 109
Indianapolis, IN 46260
Phone (317) 802-9900
68 E 3rd St
Peru, IN 46970
Phone (317) 473-4943
8 John Kissinger Dr
Ofc
Wabash, IN 46992
Phone (765) 473-4943
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 01051162A | IN | Yes |
Addresses
Primary practice location
8091 Township Line Rd
Suite 109
Indianapolis, IN 46260-2494
Mailing address
8091 Township Line Rd
Suite 109
Indianapolis, IN 46260-2494
Phone (317) 802-9900
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.