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General NPI Number Information
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NPI Number | 1033210828
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDICS & SPORTS MEDICINE OWENSBORO PSC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 2780 FREDERICA ST
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City | OWENSBORO
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State | KY
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Zip | 42301-5442
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Country | US
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Telephone | 270-926-4100
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Fax | 270-648-4678
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Provider Business Mailing Address
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Address Line | 2780 FREDERICA ST
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City | OWENSBORO
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State | KY
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Zip | 42301-5442
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Country | US
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Telephone | 270-926-4100
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Fax | 270-684-4678
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES A MILEM
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Credential | MD
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Telephone | 270-926-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00263
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License Number State | KY
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | KY
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Taxonomy #8
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | KY
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #10
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | KY
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Taxonomy #11
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | KY
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