Healthcare Provider Details

I. General information

NPI: 1871757930
Provider Name (Legal Business Name): OWENSBORO HEALTH MCAULEY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E 9TH ST
OWENSBORO KY
42303-3221
US

IV. Provider business mailing address

819 E 9TH ST
OWENSBORO KY
42303-3221
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-6575
  • Fax: 270-691-8351
Mailing address:
  • Phone: 270-926-6575
  • Fax: 270-691-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number740041
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN T HACKBARTH JR.
Title or Position: SECRETARY
Credential:
Phone: 270-417-4813