Healthcare Provider Details

I. General information

NPI: 1033816194
Provider Name (Legal Business Name): EMERGENCY MEDICINE SERVICES OF KY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ASHLEY CIR
BOWLING GREEN KY
42104-3362
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 270-793-1000
  • Fax:
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN REBOK
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-372-5004