Provider Demographics
NPI:1164075248
Name:OWENSBORO MEDICAL PRACTICE, PLLC
Entity Type:Organization
Organization Name:OWENSBORO MEDICAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BEYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-683-8672
Mailing Address - Street 1:1200 BRECKENRIDGE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1089
Mailing Address - Country:US
Mailing Address - Phone:270-683-8672
Mailing Address - Fax:270-685-8223
Practice Address - Street 1:2754 VEACH RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6219
Practice Address - Country:US
Practice Address - Phone:270-852-7771
Practice Address - Fax:270-852-7773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWENSBORO MEDICAL PRACTICE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory