Provider Demographics
NPI:1699881862
Name:OBSTETRICS & GYNECOLOGY OF PADUCAH PSC
Entity type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY OF PADUCAH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:TOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-443-1220
Mailing Address - Street 1:PO BOX 8209
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8209
Mailing Address - Country:US
Mailing Address - Phone:270-443-1220
Mailing Address - Fax:270-443-0023
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3814
Practice Address - Country:US
Practice Address - Phone:270-443-1220
Practice Address - Fax:270-443-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5160Medicare ID - Type Unspecified