MEDICARE: ELIZABETH H OTTMAN PSC

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
1	367A00000X	Advanced Practice Midwife
2	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1558367797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH H OTTMAN PSC

Provider Business Mailing Address
First Line	:	2851 NEW HARTFORD RD
Second Line	:	STE B
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1320
Country	:	US
Telephone Number	:	270-688-6035
Fax Number	:	270-688-6056

Provider Business Practice Location Address
First Line	:	2851 NEW HARTFORD RD
Second Line	:	STE B
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1320
Country	:	US
Telephone Number	:	270-688-6035
Fax Number	:	270-688-6056

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH HAWKINS OTTMAN
Credential	:	M.D.
Telephone Number	:	270-688-6035

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/30/2015

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