Healthcare Provider Details

I. General information

NPI: 1881109304
Provider Name (Legal Business Name): COMMONWEALTH HEALTH CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARK ST STE 100
BOWLING GREEN KY
42101-1784
US

IV. Provider business mailing address

PO BOX 2697
BOWLING GREEN KY
42102-7697
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-9424
  • Fax: 270-782-9445
Mailing address:
  • Phone: 270-782-9424
  • Fax: 270-782-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RONALD GENE SOWELL
Title or Position: EXEC. VICE PRESIDENT
Credential:
Phone: 270-745-1510