Provider Demographics
NPI:1184639742
Name:EMERGENCY PHYSICIANS GROUP PSC
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOU ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-685-0216
Mailing Address - Street 1:1412 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4803
Mailing Address - Country:US
Mailing Address - Phone:270-685-0216
Mailing Address - Fax:270-685-0863
Practice Address - Street 1:811 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3258
Practice Address - Country:US
Practice Address - Phone:270-685-0216
Practice Address - Fax:270-685-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65906018Medicaid
KY65906018Medicaid