Healthcare Provider Details

I. General information

NPI: 1891886925
Provider Name (Legal Business Name): GENERAL THORACIC AND VASCULAR SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NEW HARTFORD RD
OWENSBORO KY
42303
US

IV. Provider business mailing address

2801 NEW HARTFORD RD
OWENSBORO KY
42303
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3720
  • Fax: 270-686-7331
Mailing address:
  • Phone: 270-683-3720
  • Fax: 270-686-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAMONA S OSBORNE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-683-3720