Provider Demographics
NPI:1174773188
Name:PEDIATRIC PARTNERS OF WESTERN KY
Entity type:Organization
Organization Name:PEDIATRIC PARTNERS OF WESTERN KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-8828
Mailing Address - Street 1:1102 TRIPLETT ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3104
Mailing Address - Country:US
Mailing Address - Phone:270-926-8828
Mailing Address - Fax:270-926-0760
Practice Address - Street 1:1102 TRIPLETT ST
Practice Address - Street 2:STE 1000
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3104
Practice Address - Country:US
Practice Address - Phone:270-926-8828
Practice Address - Fax:270-926-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40582173000000X
KY42304173000000X
KYPA787363AM0700X
KY3007096363L00000X
KY21411173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64214117Medicaid
KY64127582Medicaid
KY64214117Medicaid
KYC78287Medicare UPIN