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958 Collett Ave Ste 322 Bowling Green KY 42101-2309 | |
| (615) 745-9058 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 958 Collett Ave Ste 322, Bowling Green, Kentucky |
| Authorized Official Name and Position | Christian Cord Schrader (OWNER) |
| Authorized Official Contact | 2146797017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2413 Nashville Rd Ste 310 Bowling Green KY 42101-4101 Ph: () - | 958 Collett Ave Ste 322 Bowling Green KY 42101-2309 Ph: (615) 745-9058 |
| NPI Number | 1407697972 |
|---|---|
| Provider Enumeration Date | 06/06/2024 |
| Last Update Date | 01/03/2025 |
| Certification Date | 01/03/2025 |
| Medicare PECOS PAC ID | 9436698925 |
|---|---|
| Medicare Enrollment ID | O20240828002893 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407697972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Christian Cord Schrader |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598962946 PECOS PAC ID: 2163887332 Enrollment ID: I20240828003838 |
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