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720 2nd Ave Ste 307 Bowling Green KY 42101-1718 | |
| (270) 780-2760 | |
| (270) 780-2761 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 720 2nd Ave Ste 307, Bowling Green, Kentucky |
| Authorized Official Name and Position | Michele Lawless (EXECUTIVE VICE PRESIDENT & CFO) |
| Authorized Official Contact | 2707451500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2697 Bowling Green KY 42102-7697 Ph: (270) 780-2760 | 720 2nd Ave Ste 307 Bowling Green KY 42101-1718 Ph: (270) 780-2760 |
| NPI Number | 1457779795 |
|---|---|
| Provider Enumeration Date | 04/03/2014 |
| Last Update Date | 11/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457779795 | NPI | - | NPPES |
| 65931776 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
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