Provider Demographics
NPI:1457330573
Name:OH MUHLENBERG, LLC
Entity Type:Organization
Organization Name:OH MUHLENBERG, LLC
Other - Org Name:OWENSBORO HEALTH AMBULATORY SURGERY CENTER MUHLENBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKBARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-417-4813
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:440 HOPKINSVILLE ST
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-9929
Mailing Address - Fax:270-338-9282
Practice Address - Street 1:1008 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5463
Practice Address - Country:US
Practice Address - Phone:270-338-9929
Practice Address - Fax:270-338-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300142261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100171220Medicaid
K148050Medicare PIN