Healthcare Provider Details

I. General information

NPI: 1235477266
Provider Name (Legal Business Name): BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 FAIRVIEW AVE SUITE A-8
BOWLING GREEN KY
42101-2367
US

IV. Provider business mailing address

730 FAIRVIEW AVE SUITE A-8
BOWLING GREEN KY
42101-2367
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-2550
  • Fax: 270-796-6569
Mailing address:
  • Phone: 270-796-2550
  • Fax: 270-796-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD G. SOWELL
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 270-745-1500