Provider Demographics
NPI:1992729529
Name:PENNYRILE UROLOGY PSC
Entity type:Organization
Organization Name:PENNYRILE UROLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-886-5141
Mailing Address - Street 1:219 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1911
Mailing Address - Country:US
Mailing Address - Phone:270-886-5141
Mailing Address - Fax:270-885-1877
Practice Address - Street 1:219 W 17TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1911
Practice Address - Country:US
Practice Address - Phone:270-886-5141
Practice Address - Fax:270-885-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65910036Medicaid
8036Medicare ID - Type UnspecifiedHOPKINSVILLE OFFICE
7694Medicare ID - Type UnspecifiedRAILROAD
KY65910036Medicaid
3654Medicare ID - Type UnspecifiedPRINCETON OFFICE