Provider Demographics
NPI:1215186143
Name:GLASGOW URGENT CLINIC, INC.
Entity Type:Organization
Organization Name:GLASGOW URGENT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:MANION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-651-7796
Mailing Address - Street 1:411 S L ROGERS WELLS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1191
Mailing Address - Country:US
Mailing Address - Phone:270-651-7796
Mailing Address - Fax:270-651-7074
Practice Address - Street 1:411 S L ROGERS WELLS BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1191
Practice Address - Country:US
Practice Address - Phone:270-651-7796
Practice Address - Fax:270-651-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3811Medicare PIN