Provider Demographics
NPI:1255498648
Name:JAY TOMES DAVIS, MD, OBSTETRICS & GYNECOLOGY PSC
Entity Type:Organization
Organization Name:JAY TOMES DAVIS, MD, OBSTETRICS & GYNECOLOGY PSC
Other - Org Name:JAY T. DAVIS, M.D., PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-843-5133
Mailing Address - Street 1:546 PARK STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1780
Mailing Address - Country:US
Mailing Address - Phone:270-843-5133
Mailing Address - Fax:270-843-5028
Practice Address - Street 1:546 PARK STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1780
Practice Address - Country:US
Practice Address - Phone:270-843-5133
Practice Address - Fax:270-843-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25834207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000062935OtherANTHEM BLUE SHIELD
KYD95924Medicare UPIN
KY000000062935OtherANTHEM BLUE SHIELD
KYP100041163Medicare PIN