Provider Demographics
NPI:1255568184
Name:OWENSBORO MEDICAL PRACTICE, PLLC
Entity type:Organization
Organization Name:OWENSBORO MEDICAL PRACTICE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:F MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-691-1830
Mailing Address - Street 1:1200 BRECKENRIDGE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1089
Mailing Address - Country:US
Mailing Address - Phone:270-683-8672
Mailing Address - Fax:270-691-1830
Practice Address - Street 1:215 HILL STREET
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:KY
Practice Address - Zip Code:42352
Practice Address - Country:US
Practice Address - Phone:270-278-2531
Practice Address - Fax:270-278-9221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWENSBORO MEDICAL PRACTICE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty