Organization
SOUTHERN KENTUCKY UROLOGY LLC
Active
Other names
Southern Kentucky Urology
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK LOCKE (VICE PRESIDENT)
(615) 373-7604
Entity
Organization
Contact information
Practice address
1325 ANDREA ST, SUITE 103, BOWLING GREEN, KY 42104-5852
(270) 796-9191
Mailing address
1325 ANDREA ST, SUITE 103, BOWLING GREEN, KY 42104-5852
(270) 796-9191
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01046326A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100003160
—
KY
Enumeration date
06/17/2006
Last updated
04/20/2008
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