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General NPI Number Information
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NPI Number | 1407924806
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Entity Type | Organization
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Legal Business Name | MACLIMORE CLINIC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2200 E PARRISH AVE BLDG C STE 104
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City | OWENSBORO
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State | KY
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Zip | 42303-1449
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Country | US
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Telephone | 270-852-1632
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Fax | 270-852-1633
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Provider Business Mailing Address
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Address Line | 4551 SPRINGHILL DR STE 3
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City | OWENSBORO
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State | KY
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Zip | 42303-4672
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Country | US
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Telephone | 270-852-1632
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Fax | 270-852-1633
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JASON L ABNEY
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Credential | RT(R)
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Telephone | 270-852-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 340
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 334
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License Number State | KY
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Taxonomy #3
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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 #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17376
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License Number State | KY
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