Provider Demographics
NPI:1134668916
Name:OWENSBORO HEALTH MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:OWENSBORO HEALTH MEDICAL GROUP, INC
Other - Org Name:INBALANCE DIABETES EDUCATION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:270-688-3252
Mailing Address - Street 1:1006 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4677
Mailing Address - Country:US
Mailing Address - Phone:270-688-5147
Mailing Address - Fax:270-688-2345
Practice Address - Street 1:1006 FORD AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4677
Practice Address - Country:US
Practice Address - Phone:270-688-5147
Practice Address - Fax:270-688-2345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWENSBORO HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-14
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty