Healthcare Provider Details

I. General information

NPI: 1801892179
Provider Name (Legal Business Name): LINDA A MUNFORD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 TRIPLETT ST STE 4
OWENSBORO KY
42303-3118
US

IV. Provider business mailing address

922 TRIPLETT ST STE 4
OWENSBORO KY
42303-3118
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-4175
  • Fax: 270-686-9507
Mailing address:
  • Phone: 270-926-4175
  • Fax: 270-686-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number23427
License Number StateKY

VIII. Authorized Official

Name: LINDA A MUMFORD
Title or Position: PRESIDENT
Credential: MD
Phone: 270-926-4175