MEDICARE: OWENSBORO HEALTH MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	KY
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	KY
3	207RI0011X	Interventional Cardiology Physician	KY
4	207RC0000X	Cardiovascular Disease Physician	KY
5	207RP1001X	Pulmonary Disease Physician	KY
6	363LF0000X	Family Nurse Practitioner	KY
7	1041C0700X	Clinical Social Worker
8	363A00000X	Physician Assistant	KY
9	101YP2500X	Professional Counselor
10	208000000X	Pediatrics Physician	KY
11	363L00000X	Nurse Practitioner
12	207RR0500X	Rheumatology Physician	KY
13	207P00000X	Emergency Medicine Physician	KY
14	2083X0100X	Occupational Medicine Physician	KY
15	207Q00000X	Family Medicine Physician	KY

General Provider Information

NPI Number	:	1376594242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OWENSBORO HEALTH MEDICAL GROUP, INC

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	:	2211 MAYFAIR DR STE 101
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301
Country	:	US
Telephone Number	:	270-688-1352
Fax Number	:	270-683-4313

Authorized Official
Title or Position	:	CRED SPECIALIST
Name	:	TERESA ANN PENNINGTON
Credential	:
Telephone Number	:	270-691-8070

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	12/18/2025

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