Healthcare Provider Details

I. General information

NPI: 1124058896
Provider Name (Legal Business Name): BOWLING GREEN ANESTHESIOLOGY ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 ASHLEY CIR SUITE 209A
BOWLING GREEN KY
42104-3337
US

IV. Provider business mailing address

PO BOX 2020
BOWLING GREEN KY
42102-2020
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-9994
  • Fax: 270-842-5048
Mailing address:
  • Phone: 270-782-9994
  • Fax: 270-842-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: STACIA DECKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-782-9994