Provider Demographics
NPI:1922152123
Name:GLASGOW PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:GLASGOW PEDIATRIC ASSOCIATES
Other - Org Name:GREENSBURG HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-651-9696
Mailing Address - Street 1:301 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3487
Mailing Address - Country:US
Mailing Address - Phone:270-651-9696
Mailing Address - Fax:
Practice Address - Street 1:2680 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-8898
Practice Address - Country:US
Practice Address - Phone:270-299-2222
Practice Address - Fax:270-299-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty