Provider Demographics
NPI:1639353642
Name:HAROLD W OWENS, M.D.
Entity Type:Organization
Organization Name:HAROLD W OWENS, M.D.
Other - Org Name:IRVINGTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:WILBUR
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-547-2011
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146-0367
Mailing Address - Country:US
Mailing Address - Phone:270-547-2011
Mailing Address - Fax:270-547-2031
Practice Address - Street 1:109 CAROLINE ST.
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:KY
Practice Address - Zip Code:40146-0367
Practice Address - Country:US
Practice Address - Phone:270-547-2011
Practice Address - Fax:270-547-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13345208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64133457Medicaid
000000062613OtherANTHEM
011769099OtherRR MEDICARE
1265701OtherMEDICARE
1049319OtherPASSPORT
C72432Medicare UPIN