Healthcare Provider Details

I. General information

NPI: 1386768604
Provider Name (Legal Business Name): CONTEMPORARY OBGYN OF WESTERN KENTUCKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 KENTUCKY AVE SUITE 103
PADUCAH KY
42003-3800
US

IV. Provider business mailing address

2605 KENTUCKY AVE SUITE 103
PADUCAH KY
42003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-9199
  • Fax: 270-444-9299
Mailing address:
  • Phone: 270-444-9199
  • Fax: 270-444-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37833
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number37833
License Number StateKY

VIII. Authorized Official

Name: DR. SUSAN MUELLER
Title or Position: PRESIDENT,PHYSICIAN
Credential: M.D.
Phone: 270-444-9199