Provider Demographics
NPI:1215369905
Name:THE WOMEN'S PAVILION, PSC APRN GROUP
Entity Type:Organization
Organization Name:THE WOMEN'S PAVILION, PSC APRN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-3700
Mailing Address - Street 1:2200 E PARRISH AVE STE 201
Mailing Address - Street 2:BLDG B
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-926-3700
Mailing Address - Fax:270-926-2114
Practice Address - Street 1:2200 E PARRISH AVE STE 201
Practice Address - Street 2:BLDG B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-3700
Practice Address - Fax:270-926-2114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WOMEN'S PAVILION, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty