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General NPI Number Information
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NPI Number | 1003364373
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Entity Type | Organization
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Legal Business Name | VERDANT HEALTHCARE LLC
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 1300 ANDREA ST SUITE 100
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3382
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Country | US
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Telephone | 270-780-3546
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Fax | 270-780-3547
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Provider Business Mailing Address
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Address Line | 1300 ANDREA ST SUITE 100
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3382
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Country | US
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Telephone | 270-780-3546
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Fax | 270-780-3547
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Authorized Official
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Title or Position | OWNER
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Name | DR. DWIGHT HOWELL SUTTON
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Credential | MD
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Telephone | 270-780-3546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 40753
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License Number State | KY
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