Provider Demographics
NPI:1013919091
Name:PULMONARY ASSOCIATES OF OWENSBORO PSC
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES OF OWENSBORO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-8810
Mailing Address - Street 1:PO BOX 1875
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1875
Mailing Address - Country:US
Mailing Address - Phone:270-926-8810
Mailing Address - Fax:270-926-7955
Practice Address - Street 1:1000 BRECKENRIDGE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0839
Practice Address - Country:US
Practice Address - Phone:270-926-8810
Practice Address - Fax:270-926-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15D5OtherBLUE CROSS BLUE SHIELD
KY78902335Medicaid
021103000OtherDEPT OF LABOR
IN200034800AMedicaid
KY65925059Medicaid
CK4221OtherRR MEDICARE
KY78902335Medicaid
KY3428Medicare ID - Type Unspecified