OWENSBORO PEDIATRICS LLC

Provider Demographics

• NPI: 1720092240
• Name: OWENSBORO PEDIATRICS LLC
• Entity Type: Organization
• Organization Name: OWENSBORO PEDIATRICS LLC
• Authorized Official - Title/Position: PRACTICE ADMINISTRATOR
• Authorized Official - First Name: WILLIAM
• Authorized Official - Middle Name: LOYD
• Authorized Official - Last Name: BUCK
• Authorized Official - Phone: 270-683-3232
• Mailing Address - Street 1: 2200 E PARRISH AVE
• Mailing Address - Street 2: BLDG B SUITE 101
• Mailing Address - City: OWENSBORO
• Mailing Address - State: KY
• Mailing Address - Zip Code: 42303
• Mailing Address - Country: US
• Mailing Address - Phone: 270-683-3232
• Mailing Address - Fax: 270-852-1600
• Practice Address - Street 1: 2200 E PARRISH AVE
• Practice Address - Street 2: BLDG B SUITE 101
• Practice Address - City: OWENSBORO
• Practice Address - State: KY
• Practice Address - Zip Code: 42303
• Practice Address - Country: US
• Practice Address - Phone: 270-683-3232
• Practice Address - Fax: 270-852-1600
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-28
• Last Update Date: 2024-02-27

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	1172074	Medicaid
KY	65939241	Medicaid
IN	2003226760A	Medicaid
KY	65939241	Medicaid
KY	1172074	Medicaid
IN	2003226760A	Medicaid