Basic Information
| Provider Information | |||||||||
| NPI: | 1922152123 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GLASGOW PEDIATRIC ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GREENSBURG HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 PROFESSIONAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421413487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706519696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2680 CAMPBELLSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427438898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702992222 | ||||||||
| FaxNumber: | 2702992211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | DENNISON | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2706519696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.