Provider Demographics
NPI:1306958343
Name:MED 1ST OF OWENSBORO
Entity type:Organization
Organization Name:MED 1ST OF OWENSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:POELING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-471-8630
Mailing Address - Street 1:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47724-0506
Mailing Address - Country:US
Mailing Address - Phone:812-471-8630
Mailing Address - Fax:812-471-8640
Practice Address - Street 1:3600 FREDERICA ST
Practice Address - Street 2:SUITEA
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6981
Practice Address - Country:US
Practice Address - Phone:270-926-1774
Practice Address - Fax:270-926-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation