Healthcare Provider Details

I. General information

NPI: 1396940599
Provider Name (Legal Business Name): HUGH SIMS MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NEW TOWNE DRIVE
BOWLING GREEN KY
42103
US

IV. Provider business mailing address

340 NEW TOWNE DRIVE
BOWLING GREEN KY
42103
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-7768
  • Fax: 270-781-9480
Mailing address:
  • Phone: 270-782-7768
  • Fax: 270-781-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2955P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number30304
License Number StateKY

VIII. Authorized Official

Name: HUGH M. SIMS III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 270-782-7768