Provider Demographics
NPI:1801892179
Name:LINDA A MUNFORD PSC
Entity type:Organization
Organization Name:LINDA A MUNFORD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-4175
Mailing Address - Street 1:922 TRIPLETT ST
Mailing Address - Street 2:STE 4
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3118
Mailing Address - Country:US
Mailing Address - Phone:270-926-4175
Mailing Address - Fax:270-686-9507
Practice Address - Street 1:922 TRIPLETT ST
Practice Address - Street 2:STE 4
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3118
Practice Address - Country:US
Practice Address - Phone:270-926-4175
Practice Address - Fax:270-686-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23427207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty