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ADVANCED UROLOGIC SURGEONS PC
NPI 1093901340
Specialist in Mount Vernon, IL

Active since September 20, 2007CLIA 14D1048280 · Waiver
604 SEVILLE DR, MOUNT VERNON, IL 62864(618) 244-4060(618) 244-4061 Get Directions Write a Review

NPPES record last updated: April 29, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Advanced Urologic Surgeons Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ADVANCED UROLOGIC SURGEONS PC (NPI 1093901340) is a healthcare organization registered as a specialist in Mount Vernon, Illinois and active in the NPI registry since September 2007. The organization holds a CLIA Waiver certificate valid through November 28, 2027 and lists David Knowles, Owner, as its authorized official.

NPPES Registry Identity

NPI1093901340
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameADVANCED UROLOGIC SURGEONS PC
Location Address604 SEVILLE DRMount Vernon, IL 62864-7001
Mailing Address604 Seville DrMount Vernon, IL 62864-7001 · (618) 244-4060 · Fax (618) 244-4061
Phone(618) 244-4060
Fax(618) 244-4061
Organization SubpartNo
Authorized OfficialDavid KnowlesOwner · (618) 244-4060
Enumeration DateSeptember 20, 2007
Last NPPES UpdateApril 29, 2010
✔ NPI 1093901340 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in IL · 036114878
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
604 SEVILLE DR, Mount Vernon, IL 62864
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Other Identifiers 3

Medicare PIN212938IL
OtherDE2609IL · Railroad
Medicare UPINH81965IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D1048280

Advanced Urologic Surgeons · Mount Vernon, IL
Active · expires Nov 28, 2027
CLIA Number14D1048280
Laboratory TypePhysician Office
Certificate Effective DateNovember 29, 2025
Certificate Expiration DateNovember 28, 2027
Laboratory DirectorDavid R. Knowles
Laboratory Phone(618) 244-4060
Laboratory LocationAdvanced Urologic Surgeons4109 S Watertower Pl, Mount Vernon, IL 62864
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Advanced Urologic Surgeons PC's NPI number?

The NPI number for Advanced Urologic Surgeons PC is 1093901340. It was assigned to this organization in the NPPES registry on September 20, 2007.

Where is Advanced Urologic Surgeons PC located?

Advanced Urologic Surgeons PC is located at 604 Seville Dr, Mount Vernon, IL 62864. The listed phone number is (618) 244-4060.

What is Advanced Urologic Surgeons PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Advanced Urologic Surgeons PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1048280) is associated with this NPI, valid through November 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Advanced Urologic Surgeons PC was last updated on April 29, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.