| Verdant Healthcare Llc | |
|
1300 Andrea St Suite 100 Bowling Green KY 42104-3382 | |
| (270) 780-3546 | |
| (270) 780-3547 |
| Full Name | Verdant Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 Andrea St, Bowling Green, Kentucky |
| Authorized Official Name and Position | Dwight Howell Sutton (OWNER) |
| Authorized Official Contact | 2707803546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Verdant Healthcare Llc 1300 Andrea St Suite 100 Bowling Green KY 42104-3382 Ph: (270) 780-3546 | Verdant Healthcare Llc 1300 Andrea St Suite 100 Bowling Green KY 42104-3382 Ph: (270) 780-3546 |
| NPI Number | 1003364373 |
|---|---|
| Provider Enumeration Date | 09/15/2016 |
| Last Update Date | 11/08/2016 |
| Medicare PECOS PAC ID | 1355629239 |
|---|---|
| Medicare Enrollment ID | O20161027001063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003364373 | NPI | - | NPPES |
| 7100017480 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 40753 (Kentucky) | Primary |
| Provider Name | Dwight H Sutton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033245378 PECOS PAC ID: 4688758840 Enrollment ID: I20080226000778 |
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