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904 Lily Creek Rd Ste 201 Middletown KY 40243-2818 | |
| (502) 357-3900 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 904 Lily Creek Rd Ste 201, Middletown, Kentucky |
| Authorized Official Name and Position | Priscilla N Owusu (PHYSICIAN) |
| Authorized Official Contact | 2038052751 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
904 Lily Creek Rd Ste 201 Middletown KY 40243-2818 Ph: (502) 357-3900 | 904 Lily Creek Rd Ste 201 Middletown KY 40243-2818 Ph: (502) 357-3900 |
| NPI Number | 1083374375 |
|---|---|
| Provider Enumeration Date | 12/28/2021 |
| Last Update Date | 04/30/2024 |
| Medicare PECOS PAC ID | 7214321108 |
|---|---|
| Medicare Enrollment ID | O20220217002384 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083374375 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Priscilla Nana Ama Owusu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164717492 PECOS PAC ID: 5698996304 Enrollment ID: I20180116002967 |