Provider Demographics
NPI:1851374003
Name:PATTERSON, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLDG D
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-8171
Practice Address - Fax:270-852-4574
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039491A2085R0202X
KY340382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64878242Medicaid
IN100468500Medicaid
IN100468500Medicaid
KY3397755Medicare PIN
KY64878242Medicaid
KY0691679Medicare PIN
KYP00236548Medicare PIN
IN100468500Medicaid
KY0935303Medicare PIN
KY3397755Medicare PIN
IN241630UMedicare ID - Type UnspecifiedFLOYD OFFICE
IN121210UMedicare Oscar/Certification
KY000000569162OtherANTHEM # COOP HEALTH