Healthcare Provider Details

I. General information

NPI: 1386638666
Provider Name (Legal Business Name): GLASGOW URGENT CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4863B SCOTTSVILLE RD
BOWLING GREEN KY
42104-7855
US

IV. Provider business mailing address

4863B SCOTTSVILLE RD
BOWLING GREEN KY
42104-7855
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-5662
  • Fax: 270-843-5614
Mailing address:
  • Phone: 270-843-5662
  • Fax: 270-843-5614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. KENNY JOE MANION
Title or Position: OWNER CEO
Credential: MD
Phone: 270-651-7796