Anderson Urologic Associates, P.C.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

50002645A Issued in IN

Legal business name

ANDERSON UROLOGIC ASSOCIATES, P.C.

Practice address

141 W 22ND St
Suite 213
Anderson, IN 46016-4304

Phone

(765) 643-0766

Fax

(765) 640-2353

NPI assigned

Feb 24, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randall Charles Blake, M.D.

Title

President

Phone

(765) 643-0766

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194791509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W 22ND ST",
            "address_2": "SUITE 213",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164304",
            "telephone_number": "765-643-0766",
            "fax_number": "765-640-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W 22ND ST",
            "address_2": "SUITE 213",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164304",
            "telephone_number": "765-643-0766",
            "fax_number": "765-640-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON UROLOGIC ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-643-0766",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "50002645A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "50002645A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anderson Oral and Maxillofacial Surgery (AOMS,llc)
• Anderson Pathologists Inc. PC
• Anderson Pediatric Dentistry
• Anderson Post Acute, LLC (Providence Anderson)
• Anderson Psychiatric Clinic LLC
• Anderson Westend Dental LLC
• Celia Anderson
• Jared Anderson, MD
• Kevin R Anderson, LCSW
• Robert W Anderson, MD

• Urology Physician in Anderson, IN
• Providers in Anderson, IN by specialty
• Urology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.