Healthcare Provider Details

I. General information

NPI: 1104470699
Provider Name (Legal Business Name): COMMONWEALTH HEALTH CORPORATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 ASHLEY ST STE 303
BOWLING GREEN KY
42103-2451
US

IV. Provider business mailing address

PO BOX 2697
BOWLING GREEN KY
42102-7697
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-8960
  • Fax: 270-842-5683
Mailing address:
  • Phone: 270-745-1100
  • Fax: 270-745-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

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