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Organization subpart
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Provider details

NPI number
Authorized official
COLLEEN O'CONNOR MCCLARY (OWNER)
(270) 685-2001
Entity
Organization

Contact information

Practice address
1725 E 18TH ST, OWENSBORO, KY 42303-1150
(270) 685-2001
(270) 685-2000
Mailing address
1725 E 18TH ST, OWENSBORO, KY 42303-1150
(270) 685-2001
(270) 685-2000

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000211325
ANTHEM
05
200124680
IN
05
90450305
KY
Enumeration date
03/01/2007
Last updated
06/23/2008
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