Provider Demographics
NPI:1922195270
Name:ORTHOPAEDICS & SPORTS MEDICINE OWENSBORO PSC
Entity Type:Organization
Organization Name:ORTHOPAEDICS & SPORTS MEDICINE OWENSBORO PSC
Other - Org Name:ADVANCED CENTER FOR ORTHOPEDICS & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-4100
Mailing Address - Street 1:2831 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1320
Mailing Address - Country:US
Mailing Address - Phone:270-926-4100
Mailing Address - Fax:270-684-4678
Practice Address - Street 1:2831 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-926-4100
Practice Address - Fax:270-684-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0307270001Medicare NSC