Healthcare Provider Details

I. General information

NPI: 1730411562
Provider Name (Legal Business Name): GLASGOW PEDIATRIC ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 CAMPBELLSVILLE ROAD
GREENSBURG KY
42743-0001
US

IV. Provider business mailing address

2680 CAMPBELLSVILLE ROAD
GREENSBURG KY
42743-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-327-8588
  • Fax:
Mailing address:
  • Phone: 859-327-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CONNIE J HORN
Title or Position: PROJECT MANAGER
Credential:
Phone: 859-327-8588