| Robert Fane Agency, Llcp | |
|
1011 Lehman Ave Suite 103 Bowling Green KY 42103-6515 | |
| (270) 393-9833 | |
| (270) 393-9835 |
| Full Name | Robert Fane Agency, Llcp |
|---|---|
| Speciality | Psychologist |
| Location | 1011 Lehman Ave, Bowling Green, Kentucky |
| Authorized Official Name and Position | Robert Bruce Fane (OWNER) |
| Authorized Official Contact | 2703939833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Fane Agency, Llcp 1011 Lehman Ave Suite 103 Bowling Green KY 42103-6515 Ph: (270) 393-9833 | Robert Fane Agency, Llcp 1011 Lehman Ave Suite 103 Bowling Green KY 42103-6515 Ph: (270) 393-9833 |
| NPI Number | 1639341126 |
|---|---|
| Provider Enumeration Date | 03/25/2008 |
| Last Update Date | 10/21/2014 |
| Medicare PECOS PAC ID | 5496150526 |
|---|---|
| Medicare Enrollment ID | O20210826003293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639341126 | NPI | - | NPPES |
| 29200912 | Medicaid | KY | |
| 29100914 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 1104 (Kentucky) | Primary |
| Provider Name | Robert B Fane |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144313248 PECOS PAC ID: 4688612930 Enrollment ID: I20050419000165 |
| Provider Name | Meredith M Fane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609168350 PECOS PAC ID: 1456749548 Enrollment ID: I20211021002360 |
| Provider Name | Mersiha Demirovic |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942735485 PECOS PAC ID: 4880085901 Enrollment ID: I20211228002517 |
| Provider Name | Christine Serafini-sheffield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730730532 PECOS PAC ID: 6800260175 Enrollment ID: I20230328002387 |
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