# SOUTHERN KENTUCKY UROLOGY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Kentucky Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114962867
- **Authorized official:** CHUCK LOCKE (VICE PRESIDENT)
- **Authorized official phone:** (615) 373-7604

## Contact information

- **Practice address:** 1325 ANDREA ST, SUITE 103, BOWLING GREEN, KY 42104-5852
- **Practice address phone:** (270) 796-9191
- **Mailing address:** 1325 ANDREA ST, SUITE 103, BOWLING GREEN, KY 42104-5852
- **Mailing address phone:** (270) 796-9191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 01046326A | IN | Yes |

## Other

- **Enumeration date:** 06/17/2006
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100003160 | — | KY |