Provider Demographics
NPI:1235165606
Name:PHYSICIANS AFFILIATED CARE P.S.C.
Entity Type:Organization
Organization Name:PHYSICIANS AFFILIATED CARE P.S.C.
Other - Org Name:GASTROINTESTINAL ENDOSCOPY CENTER OF OWENSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-2273
Mailing Address - Street 1:PO BOX 1919
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1919
Mailing Address - Country:US
Mailing Address - Phone:270-926-2273
Mailing Address - Fax:270-926-5200
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-2273
Practice Address - Fax:270-926-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000333384OtherANTHEM BC/BS
IN200491020AMedicaid
KY36001345Medicaid
IN200491020AMedicaid