Provider Demographics
NPI:1902514904
Name:SEBREE MEDICAL GROUP
Entity Type:Organization
Organization Name:SEBREE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-456-4591
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:SEBREE
Mailing Address - State:KY
Mailing Address - Zip Code:42455-0180
Mailing Address - Country:US
Mailing Address - Phone:270-318-5088
Mailing Address - Fax:270-318-3131
Practice Address - Street 1:7139 STATE ROUTE 56 E
Practice Address - Street 2:
Practice Address - City:SEBREE
Practice Address - State:KY
Practice Address - Zip Code:42455-2136
Practice Address - Country:US
Practice Address - Phone:270-318-5088
Practice Address - Fax:270-318-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health