Healthcare Provider Details

I. General information

NPI: 1750475596
Provider Name (Legal Business Name): THE WOMEN'S PAVILION, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BLDG B STE 201
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E PARRISH AVE BLDG B STE 201
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-3700
  • Fax: 270-926-2114
Mailing address:
  • Phone: 270-926-3700
  • Fax: 270-926-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. ANNETTE F HAGAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-926-3700