Healthcare Provider Details

I. General information

NPI: 1003295783
Provider Name (Legal Business Name): ALLIED PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BUILDING A
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E PARRISH AVE BUILDING A
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2273
  • Fax: 270-926-5200
Mailing address:
  • Phone: 270-926-2273
  • Fax: 270-926-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number200303
License Number StateKY

VIII. Authorized Official

Name: MR. DREW AUGENSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 270-314-2552