Organization
PROFESSIONAL PARK DIAGNOSTICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK BRIAN GIPE MD (PARTNER)
(270) 685-1066
Entity
Organization
Contact information
Practice address
3346 PROFESSIONAL PARK, OWENSBORO, KY 42303-4551
(270) 685-1066
(270) 713-0227
Mailing address
3346 PROFESSIONAL PARK, OWENSBORO, KY 42303-4551
(270) 685-1066
(270) 713-0227
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100633920
—
KY
Enumeration date
05/14/2019
Last updated
12/19/2019
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