Healthcare Provider Details

I. General information

NPI: 1568611739
Provider Name (Legal Business Name): GLASGOW URGENT CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S L ROGERS WELLS BLVD
GLASGOW KY
42141-1191
US

IV. Provider business mailing address

411 S L ROGERS WELLS BLVD
GLASGOW KY
42141-1191
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-7796
  • Fax: 270-651-7074
Mailing address:
  • Phone: 270-651-7796
  • Fax: 270-651-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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