Healthcare Provider Details

I. General information

NPI: 1861731168
Provider Name (Legal Business Name): OWENSBORO HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FARRELL CRES
OWENSBORO KY
42303-1393
US

IV. Provider business mailing address

1201 PLEASANT VALLEY RD
OWENSBORO KY
42303-9811
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-9033
  • Fax:
Mailing address:
  • Phone: 270-691-8070
  • Fax: 270-691-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number300176
License Number StateKY

VIII. Authorized Official

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