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General NPI Number Information
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NPI Number | 1346045861
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Entity Type | Organization
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Legal Business Name | OWENSBORO PEDIATRICS LLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1020 N MAIN ST
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City | BEAVER DAM
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State | KY
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Zip | 42320-1553
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Country | US
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Telephone | 270-683-3232
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Fax | 270-852-1600
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Provider Business Mailing Address
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Address Line | 2200 E PARRISH AVE STE 101B
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City | OWENSBORO
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State | KY
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Zip | 42303-1450
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Country | US
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Telephone | 270-683-3232
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Fax | 270-852-1600
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | LOREN ADKINS
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Credential |
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Telephone | 270-683-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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