Healthcare Provider Details

I. General information

NPI: 1548253107
Provider Name (Legal Business Name): ANESTHESIA & PAIN SPECIALISTS OF BOWLING GREEN PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/21/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

IV. Provider business mailing address

825 2ND AVE SUITE C6
BOWLING GREEN KY
42101-1786
US

V. Phone/Fax

Practice location:
  • Phone: 270-393-1912
  • Fax: 270-393-1913
Mailing address:
  • Phone: 270-393-1912
  • Fax: 270-393-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. ROBERT KEITH NORMAN
Title or Position: PARTNER/PRESIDENT
Credential: CRNA
Phone: 270-393-1912