Provider Demographics
NPI:1275782328
Name:THE ENDOCRINE AND DIABETES CENTER PSC.
Entity Type:Organization
Organization Name:THE ENDOCRINE AND DIABETES CENTER PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:270-852-1655
Mailing Address - Street 1:2200 EAST PARRISH AVE. BUILDING E. SUITE 101
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-852-1655
Mailing Address - Fax:270-297-4962
Practice Address - Street 1:2200 EAST PARRISH AVE. BUILDING E. SUITE 101
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-852-1655
Practice Address - Fax:270-297-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-13
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40781207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty