Healthcare Provider Details

I. General information

NPI: 1346045861
Provider Name (Legal Business Name): OWENSBORO PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N MAIN ST
BEAVER DAM KY
42320-1553
US

IV. Provider business mailing address

2200 E PARRISH AVE STE 101B
OWENSBORO KY
42303-1450
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3232
  • Fax: 270-852-1600
Mailing address:
  • Phone: 270-683-3232
  • Fax: 270-852-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOREN ADKINS
Title or Position: CLINICAL MANAGER
Credential:
Phone: 270-683-3232