Healthcare Provider Details

I. General information

NPI: 1649824426
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS OF WESTERN KENTUCKY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HOPKINSVILLE ST
GREENVILLE KY
42345-1104
US

IV. Provider business mailing address

480 HOPKINSVILLE ST
GREENVILLE KY
42345-1124
US

V. Phone/Fax

Practice location:
  • Phone: 270-338-6488
  • Fax: 270-338-7868
Mailing address:
  • Phone: 270-338-5777
  • Fax: 270-338-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ALLEN SWAB
Title or Position: CFO
Credential:
Phone: 270-338-5777