Healthcare Provider Details

I. General information

NPI: 1932139235
Provider Name (Legal Business Name): MIDWEST EAR NOSE & THROAT HEAD & NECK SURGERY OF OWENSBORO PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 NEW HARTFORD RD
OWENSBORO KY
42303
US

IV. Provider business mailing address

2841 NEW HARTFORD RD
OWENSBORO KY
42303-1320
US

V. Phone/Fax

Practice location:
  • Phone: 270-691-6161
  • Fax: 270-926-2364
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS C LOGAN
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 270-691-6161