Healthcare Provider Details

I. General information

NPI: 1699881862
Provider Name (Legal Business Name): OBSTETRICS & GYNECOLOGY OF PADUCAH PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 KENTUCKY AVE SUITE 201
PADUCAH KY
42003-3814
US

IV. Provider business mailing address

PO BOX 8209
PADUCAH KY
42002-8209
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-1220
  • Fax: 270-443-0023
Mailing address:
  • Phone: 270-443-1220
  • Fax: 270-443-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEWART BLAIR TOLAR
Title or Position: PRESIDENT
Credential:
Phone: 270-443-1220