Healthcare Provider Details

I. General information

NPI: 1235366238
Provider Name (Legal Business Name): OWENSBORO MEDICAL PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 STATE ROUTE 271 S
LEWISPORT KY
42351-6701
US

IV. Provider business mailing address

1200 BRECKENRIDGE ST SUITE 101
OWENSBORO KY
42303-1089
US

V. Phone/Fax

Practice location:
  • Phone: 270-927-9991
  • Fax: 270-927-9990
Mailing address:
  • Phone: 270-683-8672
  • Fax: 270-691-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: F MICHELE BEYKE
Title or Position: ADMINISTRATION
Credential:
Phone: 270-691-1830