MEDICARE: COMMONWEALTH OF KENTUCKY

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	313M00000X	Nursing Facility/Intermediate Care Facility	100483	KY

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	:	1972506731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH OF KENTUCKY

Provider Business Mailing Address
First Line	:	207 STATE AVE
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-1400
Country	:	US
Telephone Number	:	270-659-4700
Fax Number	:	270-651-1726

Provider Business Practice Location Address
First Line	:	207 STATE AVE
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-1400
Country	:	US
Telephone Number	:	270-659-4700
Fax Number	:	270-651-1726

Authorized Official
Title or Position	:	FACILITY DIRECTOR
Name	:	MS. AMANDA ALLEN
Credential	:
Telephone Number	:	270-659-4707

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/28/2024

Similar Medicare Providers

1154825289 — SHAMMI A PATEL DO
Practice Location Address:

310 N L ROGERS WELLS BLVD
GLASGOW, KY
42141-1300

Practice Phone: 270-659-5990
Practice Fax: 270-659-5947

1932907144 — BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION
Practice Location Address:

401 S L ROGERS WELLS BLVD
GLASGOW, KY
42141

Practice Phone: 270-261-5640
Practice Fax: 270-261-5643

1700860319 — BARREN RIVER REGIONAL CANCER CENTER, INC.
Practice Location Address:

103 TRISTA LN
GLASGOW, KY
42141-3482

Practice Phone: 270-651-2478
Practice Fax: 270-651-9264

1134122336 — MR. NARASIMHA REDDY M.D.
Practice Location Address:

106 COLUMNS PLAZA DR
GLASGOW, KY
42141-8068

Practice Phone: 270-651-9393
Practice Fax: 270-651-8698

1407859630 — MR. BARRET LESSENBERRY M.D.
Practice Location Address:

106 COLUMNS PLAZA DR
GLASGOW, KY
42141-8068

Practice Phone: 270-651-9390
Practice Fax: 270-651-8698

1407850134 — MICHAEL A SARIDAKIS MD
Practice Location Address:

310 N L ROGERS WELLS BLVD STE 103
GLASGOW, KY
42141-1300

Practice Phone: 270-659-5945
Practice Fax: 270-659-5855

Directions to “COMMONWEALTH OF KENTUCKY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.