Provider Demographics
NPI:1063502334
Name:MEDICAL ASSOCIATES OF SOUTHERN KENTUCKY PLLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF SOUTHERN KENTUCKY PLLC
Other - Org Name:M.A.S.K.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:THORNBURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:270-659-9696
Mailing Address - Street 1:211 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3486
Mailing Address - Country:US
Mailing Address - Phone:270-659-9696
Mailing Address - Fax:270-659-9797
Practice Address - Street 1:211 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3486
Practice Address - Country:US
Practice Address - Phone:276-935-2141
Practice Address - Fax:276-935-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363L00000X
KYPA905363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7818Medicare PIN