Provider Demographics
NPI:1508067174
Name:OWENSBORO ORTHOPEDIC CLINIC INC
Entity Type:Organization
Organization Name:OWENSBORO ORTHOPEDIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:ANWARUL
Authorized Official - Last Name:QUADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-684-3247
Mailing Address - Street 1:1700 FREDERICA ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4811
Mailing Address - Country:US
Mailing Address - Phone:270-684-3247
Mailing Address - Fax:270-684-3248
Practice Address - Street 1:1700 FREDERICA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4810
Practice Address - Country:US
Practice Address - Phone:270-684-3247
Practice Address - Fax:270-684-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17353207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0679Medicare ID - Type Unspecified