Healthcare Provider Details

I. General information

NPI: 1982737961
Provider Name (Legal Business Name): COMMONWEALTH BIOMEDICAL RESEARCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 AYER PKWY E
MADISONVILLE KY
42431-8999
US

IV. Provider business mailing address

240 EAST AYR PKWY
MADISONVILLE KY
42431-8999
US

V. Phone/Fax

Practice location:
  • Phone: 270-825-8345
  • Fax: 270-825-2975
Mailing address:
  • Phone: 270-825-8345
  • Fax: 270-825-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5766P
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34849
License Number StateKY

VIII. Authorized Official

Name: MRS. CAROLYN E WITTMER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 270-825-8345