Provider Demographics
NPI:1588813414
Name:GLASGOW URGENT CLINIC, INC
Entity Type:Organization
Organization Name:GLASGOW URGENT CLINIC, INC
Other - Org Name:SCOTTSVILLE URGENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:MANION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-651-7796
Mailing Address - Street 1:218 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1434
Mailing Address - Country:US
Mailing Address - Phone:270-237-4899
Mailing Address - Fax:270-237-4466
Practice Address - Street 1:218 N COURT ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1434
Practice Address - Country:US
Practice Address - Phone:270-237-4899
Practice Address - Fax:270-237-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933772Medicaid
KY65933772Medicaid