Provider Demographics
NPI:1366952699
Name:MCGOWAN, SENECA C (PA-C)
Entity type:Individual
Prefix:MR
First Name:SENECA
Middle Name:C
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BRECKENRIDGE LN STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1779
Mailing Address - Country:US
Mailing Address - Phone:502-259-3341
Mailing Address - Fax:502-259-3342
Practice Address - Street 1:2800 BRECKENRIDGE LN STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1779
Practice Address - Country:US
Practice Address - Phone:502-259-3341
Practice Address - Fax:502-259-3342
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA3102363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300011189Medicaid
KY7100577820Medicaid
IN300011189Medicaid