Healthcare Provider Details

I. General information

NPI: 1306046115
Provider Name (Legal Business Name): COMMONWEALTH HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 2ND AVE SUITE A3
BOWLING GREEN KY
42101-1786
US

IV. Provider business mailing address

PO BOX 2697
BOWLING GREEN KY
42102-7697
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-6847
  • Fax: 270-796-6841
Mailing address:
  • Phone: 270-745-1467
  • Fax: 270-745-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18710
License Number StateKY

VIII. Authorized Official

Name: RONALD G. SOWELL
Title or Position: EXEC. VICE PRESIDENT
Credential:
Phone: 270-745-1536