Healthcare Provider Details

I. General information

NPI: 1750972733
Provider Name (Legal Business Name): SOUTHERN KENTUCKY MOBILE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 STEEPLECHASE WAY
BOWLING GREEN KY
42103-7990
US

IV. Provider business mailing address

746 STEEPLECHASE WAY
BOWLING GREEN KY
42103-7990
US

V. Phone/Fax

Practice location:
  • Phone: 270-780-6250
  • Fax:
Mailing address:
  • Phone: 270-780-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. MEREDITH T HOWARD
Title or Position: CEO
Credential: CCMA
Phone: 270-780-6250