Provider Demographics
NPI:1487729711
Name:OWENS OBSTETRICS AND GYNECOLOGY PSC
Entity type:Organization
Organization Name:OWENS OBSTETRICS AND GYNECOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-575-4551
Mailing Address - Street 1:PO BOX 7466
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7466
Mailing Address - Country:US
Mailing Address - Phone:270-575-4551
Mailing Address - Fax:270-575-4560
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:STE 302
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3814
Practice Address - Country:US
Practice Address - Phone:270-575-4551
Practice Address - Fax:270-575-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3104Medicare PIN