Provider Demographics
NPI:1538284708
Name:NORSWORTHY MEDICAL ASSOC., PSC NURSE PRACTITIONER GROUP
Entity Type:Organization
Organization Name:NORSWORTHY MEDICAL ASSOC., PSC NURSE PRACTITIONER GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORSWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-274-1800
Mailing Address - Street 1:1219 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-8955
Mailing Address - Country:US
Mailing Address - Phone:270-274-1800
Mailing Address - Fax:270-274-5600
Practice Address - Street 1:1219 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8955
Practice Address - Country:US
Practice Address - Phone:270-274-1800
Practice Address - Fax:270-274-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3830P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7890042000Medicaid