Healthcare Provider Details

I. General information

NPI: 1700936754
Provider Name (Legal Business Name): GLASGOW PEDIATRIC ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROFESSIONAL PARK DR
GLASGOW KY
42141-3487
US

IV. Provider business mailing address

301 PROFESSIONAL PARK DR
GLASGOW KY
42141-3487
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-9696
  • Fax: 270-651-0385
Mailing address:
  • Phone: 270-651-9696
  • Fax: 270-651-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: MELISSA B DENNISON
Title or Position: OWNER
Credential: MD
Phone: 270-651-9696