Healthcare Provider Details

I. General information

NPI: 1760411342
Provider Name (Legal Business Name): BLUEGRASS OUTPATIENT CENTER OF BOWLING GREEN, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 SCOTTSVILLE RD STE 9
BOWLING GREEN KY
42104-3357
US

IV. Provider business mailing address

PO BOX 117929
ATLANTA GA
30368-7929
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-6850
  • Fax: 270-781-8228
Mailing address:
  • Phone: 270-745-1100
  • Fax: 270-745-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number100615
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELE W LAWLESS
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 270-745-1500