Healthcare Provider Details

I. General information

NPI: 1275077786
Provider Name (Legal Business Name): PHYSICIANS AFFILIATED CARE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 HEARTLAND CROSSINGS, SUITE B
OWENSBORO KY
42303
US

IV. Provider business mailing address

2200 E PARRISH AVE BLDG A
OWENSBORO KY
42303-1453
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-3774
  • Fax: 270-926-5200
Mailing address:
  • Phone: 270-926-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48529
License Number StateKY

VIII. Authorized Official

Name: JENNIFER BOARMAN
Title or Position: BILLING MANAGER
Credential:
Phone: 270-926-2273