Healthcare Provider Details

I. General information

NPI: 1093331274
Provider Name (Legal Business Name): OWENSBORO SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BLDG C
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

PO BOX 34770
BELFAST ME
04915-0625
US

V. Phone/Fax

Practice location:
  • Phone: 270-541-1410
  • Fax: 270-541-1412
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL RAY WEST JR.
Title or Position: SURGEON
Credential: MD
Phone: 502-643-9378