MEDICARE: COMMONWEALTH HEALTH CORPORATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477399350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH HEALTH CORPORATION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2697
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42102-7697
Country	:	US
Telephone Number	:	270-265-5023
Fax Number	:	270-265-5026

Provider Business Practice Location Address
First Line	:	118 S MAIN ST
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-8863
Country	:	US
Telephone Number	:	270-265-5023
Fax Number	:	270-265-5026

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT & CFO
Name	:	MICHELE LAWLESS
Credential	:
Telephone Number	:	270-745-1500

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	10/07/2025

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