MEDICARE: GLASGOW URGENT CLINIC, INC

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	207Q00000X	Family Medicine Physician	24806	KY
2	207Q00000X	Family Medicine Physician		KY

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	:	1922092642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLASGOW URGENT CLINIC, INC

Provider Business Mailing Address
First Line	:	218 NORTH COURT STREET
Second Line	:
City	:	SCOTTSVILLE
State	:	KY
Zip	:	42164-1440
Country	:	US
Telephone Number	:	270-237-4899
Fax Number	:	270-237-4466

Provider Business Practice Location Address
First Line	:	218 NORTH COURT STREET
Second Line	:
City	:	SCOTTSVILLE
State	:	KY
Zip	:	42164-1440
Country	:	US
Telephone Number	:	270-237-4899
Fax Number	:	270-237-4466

Authorized Official
Title or Position	:	OWNER/CEO/MD
Name	:	MR. KENNY JOE MANION
Credential	:	MD
Telephone Number	:	270-651-7796

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	01/02/2014

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