Basic Information
| Provider Information | |||||||||
| NPI: | 1275077786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS AFFILIATED CARE, PSC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAREPOINTE WALKIN CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E PARRISH AVE BLDG A | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709262273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2710 HEARTLAND CROSSINGS, SUITE B | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709263774 | ||||||||
| FaxNumber: | 2709265200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2016 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | BOARMAN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2709262273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 48529 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.