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General NPI Number Information
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NPI Number | 1275077786
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Entity Type | Organization
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Legal Business Name | PHYSICIANS AFFILIATED CARE, PSC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 2710 HEARTLAND CROSSINGS, SUITE B
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City | OWENSBORO
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State | KY
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Zip | 42303
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Country | US
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Telephone | 270-926-3774
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Fax | 270-926-5200
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Provider Business Mailing Address
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Address Line | 2200 E PARRISH AVE BLDG A
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City | OWENSBORO
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State | KY
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Zip | 42303-1453
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Country | US
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Telephone | 270-926-2273
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JENNIFER BOARMAN
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Credential |
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Telephone | 270-926-2273
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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 | 48529
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License Number State | KY
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