Healthcare Provider Details

I. General information

NPI: 1306221841
Provider Name (Legal Business Name): INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 N RACE ST
GLASGOW KY
42141-3462
US

IV. Provider business mailing address

350 PARK ST STE 203B
BOWLING GREEN KY
42101-1784
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-7246
  • Fax: 270-282-2027
Mailing address:
  • Phone: 270-393-1912
  • Fax: 270-393-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KEITH NORMAN
Title or Position: OWNER/PRESIDENT
Credential: CRNA
Phone: 270-393-1912