Provider Demographics
NPI:1285727420
Name:LARRY S WIGGINTON PSC
Entity type:Organization
Organization Name:LARRY S WIGGINTON PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HODSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-8222
Mailing Address - Street 1:2211 MAYFAIR DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-926-8222
Mailing Address - Fax:270-685-5101
Practice Address - Street 1:2211 MAYFAIR DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-926-8222
Practice Address - Fax:270-685-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64148562Medicaid
1184801Medicare ID - Type Unspecified
KY64148562Medicaid