Healthcare Provider Details

I. General information

NPI: 1700860319
Provider Name (Legal Business Name): BARREN RIVER REGIONAL CANCER CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 TRISTA LN
GLASGOW KY
42141-3482
US

IV. Provider business mailing address

PO BOX 1867
BOWLING GREEN KY
42102-1867
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-2478
  • Fax: 270-651-9264
Mailing address:
  • Phone: 270-745-1467
  • Fax: 270-745-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License Number730074
License Number StateKY

VIII. Authorized Official

Name: CONNIE D. SMITH
Title or Position: PRESIDENT & CEO
Credential:
Phone: 270-745-1262