Healthcare Provider Details

I. General information

NPI: 1447295852
Provider Name (Legal Business Name): BOWLING GREEN INTERNAL MEDICINE AND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 7TH AVE
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

PO BOX 9880
BOWLING GREEN KY
42102-9880
US

V. Phone/Fax

Practice location:
  • Phone: 270-846-4800
  • Fax: 270-846-4828
Mailing address:
  • Phone: 270-846-4800
  • Fax: 270-846-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL A KNIERY
Title or Position: PRESIDENT
Credential: MD
Phone: 270-846-4800