Provider Demographics
NPI:1427066018
Name:UROLOGY ASSOCIATES, S.C.
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:RIVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-258-4186
Mailing Address - Street 1:500 HEALTH CENTER DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9258
Mailing Address - Country:US
Mailing Address - Phone:217-258-4186
Mailing Address - Fax:217-258-4185
Practice Address - Street 1:500 HEALTH CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9258
Practice Address - Country:US
Practice Address - Phone:217-258-4186
Practice Address - Fax:217-258-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X, 174400000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL58333OtherMEDICARE PIN #
ILL58333OtherMEDICARE PIN #
IL247290Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER