| Wilson Place | |
|
1312 Westen St Bowling Green KY 42104-3352 | |
| (270) 904-1072 | |
| (270) 904-1073 |
| Full Name | Wilson Place |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1312 Westen St, Bowling Green, Kentucky |
| Authorized Official Name and Position | Kim R Wilson (PRESIDENT) |
| Authorized Official Contact | 2709041072 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson Place 1312 Westen St Bowling Green KY 42104-3352 Ph: (270) 904-1072 | Wilson Place 1312 Westen St Bowling Green KY 42104-3352 Ph: (270) 904-1072 |
| NPI Number | 1649640921 |
|---|---|
| Provider Enumeration Date | 09/30/2015 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649640921 | NPI | - | NPPES |
| 7100300070 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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