Healthcare Provider Details

I. General information

NPI: 1215521802
Provider Name (Legal Business Name): COMMONWEALTH HEALTH CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARK ST STE 106
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: 270-721-7265
  • Fax: 270-745-1050
Mailing address:
  • Phone: 270-721-7265
  • Fax: 270-745-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number StateNULL

VIII. Authorized Official

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