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NPI Code Detail

MEDICARE: WILLIAM S BLACK MD

MEDICARE: WILLIAM S BLACK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QS0010XSports Medicine (Family Medicine) Physician28129KY
2207Q00000XFamily Medicine Physician28129KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063478675
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM S BLACK MD
Provider Business Mailing Address
First Line : PO BOX 23229
Second Line :
City : OWENSBORO
State : KY
Zip : 42304-3229
Country : US
Telephone Number : 270-688-1330
Fax Number : 270-688-1338
Provider Business Practice Location Address
First Line : 1006 FORD AVE
Second Line :
City : OWENSBORO
State : KY
Zip : 42301-4677
Country : US
Telephone Number : 270-688-2110
Fax Number : 270-688-2111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 06/13/2023

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Directions to “ WILLIAM S BLACK MD” Practice Location

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